Laryngeal Fracture Caused by a Lacrosse Ball.

Neck injuries in lacrosse are rare and mostly involve the musculoskeletal system. The lacrosse ball is a solid rubber ball of approximately 20 cm in diameter and the fastest shot recorded in professional lacrosse is over 100 mph. Despite wearing full protection, the neck remains prone to blunt trauma by this ball. A 23-year man sustained a direct blow to his left neck by a lacrosse ball during play, resulting in immediate aphonia and stridor. CT scan confirmed a left thyroid lamina fracture. The patient was treated conservatively and his airway was monitored for 24 hours. He made a full recovery. It is important that lacrosse players should be aware of this potential injury and appropriate precautions should be taken to avoid this trauma.

Septoplasty with concomitant inferior turbinate reduction reduces the need for revision procedure.

OBJECTIVE: Septoplasty is an accepted and common surgical intervention to improve the nasal airway. However, the role of concomitant surgery on the inferior turbinate remains debated. This study aims to investigate if the inferior turbinate surgery at the time of septoplasty would impact on the likelihood of revision nasal surgery - septoplasty or septorhinoplasty. STUDY DESIGN: Retrospective review of consecutive patients undergoing septoplasty with or without inferior turbinate reduction over 12 years (1998 - 2010) at Aberdeen Royal Infirmary. METHODS: Patients were identified from the theatre log books and were excluded if they underwent any other nasal procedure. Data collected include demographics, type of primary surgery, and grade of surgeon along with revision nasal surgery in this cohort. RESULTS: 2168 eligible patients with a mean age of 39 years were investigated. Two groups were identified: Group A, with 788 patients who underwent septoplasty only, and Group B, in which 1380 patients underwent septoplasty with concomitant inferior turbinate reduction. The majority of operations were performed by the surgeons in training. The incidence of revision surgery was 5.1 % (21 revision septoplasties and 19 corrective septorhinoplasties) in Group A compared to 2.2 % (20 revision septoplasties and 10 corrective septorhinoplasties) in Group B. CONCLUSION: Based on this study, it would appear that concomitant inferior turbinate reduction may decrease the likelihood of revision nasal surgery.

Pharmacological and other interventions for head and neck cancer pain: a systematic review.

OBJECTIVES: Pain is a common complication in head and neck cancer. The aim of this paper is to evaluate the evidence from randomised control trials investigating pharmacological and non-pharmacological methods of pain management in head and neck cancer. MATERIAL AND METHODS: Medline, Embase and the Cochrane library databases were searched. Squamous cell carcinomas of the head and neck excluding nasopharyngeal and salivary gland cancers were included. The limits were "human" and "randomised clinical trials". A quality assessment was carried out. RESULTS: 13 studies were included with a total of 644 participants. The primary outcome for most of these papers was pain control post-treatment. Levels of bias varied between the studies. Majority (12 out of the 13 studies) reported intervention to be superior to the control or standard therapy in pain management. Only 46% of the studies were carried out on an intention to treat basis. Two studies reported high dropout rates, with one at 66%. CONCLUSIONS: There is insufficient evidence from randomised clinical trials to suggest an optimal pharmacological intervention for head and neck cancer pain post-treatment. Further high quality randomised clinical trials should be conducted to develop an optimal management strategy for head and neck cancer pain.

Head and neck cancer pain: systematic review of prevalence and associated factors.

OBJECTIVES: Pain is a major symptom in patients with cancer; however information on head and neck cancer related pain is limited. The aim of this review was to investigate the prevalence of pain and associated factors among patients with HNC. MATERIAL AND METHODS: The systematic review used search of MEDLINE, EMBASE and CINAHL databases to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies. RESULTS: There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 33 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis before (57%, 95% CI 43% - 70%) and after (42%, 95% CI 33% - 50%) treatment. Only 49 studies (60%) considered associated factors, mostly tumour- or treatment-related. CONCLUSIONS: The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with head and neck cancer.

Intraoperative dexamethasone and the risk of secondary posttonsillectomy hemorrhage.

OBJECTIVE: to determine whether intraoperative dexamethasone is a risk factor for secondary posttonsillectomy bleeding. DESIGN: retrospective chart review. SETTING: tertiary care referral centres in Scotland. METHOD AND PATIENTS: the charts of 530 pediatric patients undergoing tonsillectomy were reviewed over a 3-year period (January 2004 to December 2006), and data were collected regarding the use of dexamethasone intraoperatively. Data were analyzed using the SPSS for Windows statistical package (SPSS Inc, Chicago, IL). MAIN OUTCOME MEASURES: incidence of secondary posttonsillectomy bleeding. The relative risk of posttonsillectomy bleeding was measured in those receiving dexamethasone. Logistic regression analysis was performed. RESULTS: Thirty-seven episodes of secondary hemorrhage were encountered in 36 children: 9 of 253 (3.6%; 95% CI 1.6-6.7) patients receiving intraoperative dexamethasone compared to 28 of 277 (10.1%; 95% CI 6.8-14.3) not receiving dexamethasone. Six patients had to undergo an emergency reoperation to arrest bleeding, only one of whom had received dexamethasone. When added to a stepwise logistic regression model with age, gender, indication for surgery, surgeon grade, and operative technique, dexamethasone and the presence of obstructive symptoms were the only significant factors influencing the risk of bleeding. The odds ratio indicates that patients with obstructive symptoms (OR 0.16; 95% CI 0.04-0.70) and those receiving dexamethasone were less likely to develop secondary bleeding (OR 0.44; 95% CI 0.20-0.96). CONCLUSION: based on our study data, the use of intraoperative dexamethasone does not appear to increase the risk of posttonsillectomy bleeding.

Complementary and alternative medicine use by otolaryngology patients: a paradigm for practitioners in all surgical specialties.

There is growing interest in complementary and alternative medicine (CAM) amongst the general population. Little information is available on CAM use in otolaryngology patients in the UK. Despite concerns over safety, efficacy and cost-effectiveness, CAM use is common amongst ENT patients. Patients perceive these medications as possible boosters to their immune system. It is becoming increasingly important that health care providers in all specialties ask their patients about CAM use and are aware of the implications it carries. The objective is to study the prevalence and pattern of CAM use among adult and paediatric ENT patients in a UK teaching hospital. A cross-sectional study was done by sending anonymous questionnaire to all outpatient and elective inpatients over a 3-month period. Response rate was 73% (1,789/2,440). Prominent demographics: female, married, over-50 s. Sixty percent had used CAM, 35% in last year. Most common herbs: cod liver oil (n = 481), garlic (n = 255), cranberry (n = 224); non-herbal: massage (n = 287), acupuncture (n = 233), aromatherapy (n = 170). Most commonly cited reasons for using CAM: general health, enhanced immunity and prevention/treatment of common illnesses like the common cold, asthma and bodily aches and pains.

The use of complementary and alternative medicine by patients attending a general otolaryngology clinic: can we afford to ignore it?

BACKGROUND: There is growing interest in use of complementary and alternative medicine (CAM) among the general population. Little information is available, however, on CAM use in adults attending an otolaryngology outpatient clinic in the UK. OBJECTIVE: The purpose of this article is to study the prevalence and pattern of CAM use among adult patients attending the ear, nose, and throat (ENT) clinic in a UK teaching hospital. STUDY DESIGN: A cross-sectional study was used. SUBJECTS AND METHODS: All patients on their primary visit to an ENT clinic were asked to complete an anonymous questionnaire for a 14-week period from October 2005 to January 2006. RESULTS: Based on 1366 completed questionnaires, 53% (728/1366) were female and 47% (638/1366) were male. Twenty-nine percent (395/1366) were older than 60 years, and 56% (763/1366) were married. Twenty percent (275/1366) had a university education. Sixty-one percent (833/1366) had used CAM, almost 36% in the preceding 12 months. The popular remedies were cod liver oil (368/833), garlic (197/833), cranberry (181/833), aloe vera (176/833), primrose oil (174/833), and Echinacea (163/833). Nonherbal therapies included massage (230/833), acupuncture (186/833), aromatherapy (135/833), chiropractic (121/833), reflexology (119/833), and homeopathy (110/833). Seventeen percent (143/833) used CAM for their current illness. Only 8% (64/833) found CAM ineffective; yet, 57% (473/833) would recommend CAM to others. Fifty-one percent (421/833) failed to inform their primary physician of their CAM use. CONCLUSION: Despite concerns over CAM efficacy, safety, and cost effectiveness, use of CAM is popular among patients attending an ENT clinic. Their use is not generally related to their presenting illness. Otolaryngologists should be aware of current trends in CAM use when managing patients, including possible interactions with other medication.

Malignant peripheral nerve sheath tumor of the paranasal sinuses.

Malignant peripheral nerve sheath tumors of the nose and paranasal sinuses are extremely uncommon. We report the case of a 65-year-old woman who presented with a rapid emergence of "nasal polyps" that completely obstructed her nasal passages. Six years earlier she had been assessed elsewhere for nasal polyps. At presentation, the patient exhibited gross polyposis, with lesions protruding from both nostrils. Histology confirmed a diagnosis of a malignant peripheral nerve sheath tumor This case demonstrates that symptoms of nasal obstruction are not always secondary to simple causes. We discuss the clinical picture of nasal and paranasal malignant peripheral nerve sheath tumor, its pathology, and its treatment.