Use of potassium titanyl phosphate (KTP) laser Dermastat in the treatment of recurrent anterior epistaxis - a new technique.

OBJECTIVE: To evaluate the short- to medium-term effectiveness of potassium titanyl phosphate (KTP) laser Dermastat in patients with recurrent anterior epistaxis. METHOD: Fifty-eight patients presenting with recurrent anterior epistaxis were treated using potassium titanyl phosphate laser Dermastat. Those with recurrent epistaxis arising from prominent vessels in Little's area, and/or those for whom treatment with silver nitrate cautery failed, were included. The main outcome measure was resolution of epistaxis at two months. RESULTS: Fifty-eight patients were treated; 27 were under 18 years old. Thirty patients had prominent vessels. Thirty-one patients had undergone previous cautery treatment. Thirty-eight patients had treatment to the left side, 19 to the right and 1 to both. At two months, 74 per cent reported resolution of epistaxis with no complications. This increased to 78 per cent at further follow up. CONCLUSION: Our technique is a successful, safe treatment for recurrent anterior epistaxis in an otherwise treatment-resistant group. A single procedure is effective. The handpiece and tip are reusable and sterilisable, resulting in cost-effectiveness.

Risk of contamination of lidocaine hydrochloride and phenylephrine hydrochloride topical solution: in vivo and in vitro analyses.

OBJECTIVE: To investigate the risk of contamination of lidocaine hydrochloride 5 per cent weight/volume and phenylephrine hydrochloride 0.5 per cent weight/volume topical solution, both in patients (in vivo) and in the laboratory setting (in vitro). METHODS: This paper reports a prospective study involving 10 samples of the lidocaine hydrochloride and phenylephrine hydrochloride topical anaesthetic spray. The samples were assessed for microbiological contamination after a single use on patients in a controlled laboratory environment. Additional samples were assessed for baseline contamination and later assessed for contamination in an in vitro setting. RESULTS: In the in vivo setting, 2 of the 10 samples were positive for cultures from both the pump and the bottles. However, in the in vitro setting, the pump and the contents of the bottles were contaminated after a single use when the sterile solution was sprayed from distances of 1 and 2 cm. CONCLUSION: The lidocaine hydrochloride and phenylephrine hydrochloride topical solution assembly was contaminated in both in vivo and in vitro settings after a single use.

Bioplastique injection laryngoplasty: voice performance outcome.

AIM: To compare voice performance following Bioplastique injection with that following Isshiki thyroplasty. MEASURES: A 12 item, self-reported voice performance questionnaire was completed and observer-rated perceptual voice analysis scores were also measured, before and after Bioplastique injection, for 14 patients. Results were compared with our previously reported outcomes for 28 thyroplasty patients. RESULTS: Only 14 of 30 patients had complete datasets. For these patients, the mean pre-operative voice performance questionnaire score improved significantly, from 40.3 to 18.9 (p=0.002, Wilcoxon test). All perceptual analysis parameters showed significant improvement. These results compare favourably with the thyroplasty cohort (mean voice performance questionnaire score: pre-operative 35; post-operative 18; p<0.001). One Bioplastique patient developed contralateral paresis, requiring partial removal of the material 18 months later. Two thyroplasty patients experienced complications and three required revision. CONCLUSIONS: Both Bioplastique injection and Isshiki thyroplasty resulted in a significant improvement in both subjective and perceptual voice performance. Our data suggest that the effect size of the two interventions is approximately similar (in nonrandomised cohorts of surviving patients). As in many similar studies, the incomplete follow-up data reflect severe comorbidity. Bioplastique injection is a quicker procedure associated with fewer complications, and thus appears superior to framework surgery in patients with limited life expectancy.

Quality of life assessment after non-laser endonasal dacryocystorhinostomy.

OBJECTIVE: There has been a lack of patient-centred evidence in the Otolaryngology literature, that non-laser endonasal dacryocystorhinostomy improves the quality of life of patients. Many studies demonstrate successful outcomes based on non-validated subjective patient reporting. The aim of this survey was to evaluate the impact of non-laser endonasal dacryocystorhinostomy on the quality of life of patients using a validated questionnaire, the Glasgow Benefit Inventory (GBI). DESIGN: Prospective non-randomised case series. SETTING: Secondary otorhinolaryngology-ophthalmology centre, single centre. PARTICIPANTS: Sixty-five consecutive patients undergoing non-laser endonasal dacryocystorhinostomy were asked to complete a questionnaire at their follow-up clinic appointment. All patients had a minimum of 9 months follow-up. MAIN OUTCOME MEASURES: A consultant ophthalmologist reviewed each patient six months after surgery and recorded the outcomes as 'cure', 'better', 'no change' or 'worse'. We defined 'success' as cured or better. 'Failure' suggests no improvement or worsening epiphora. The validated 18-item GBI was used. RESULTS: Fully completed questionnaires were received from 55 patients. Mean total GBI scores were +34 for successful non-laser endonasal dacryocystorhinostomy and -19 for failed non-laser endonasal dacryocystorhinostomy (Mann-Whitney z = 3.8, P < 0.001). CONCLUSION: Successful non-laser endonasal dacryocystorhinostomy does confer significant quality of life improvement.