Forgotten T-tube in the middle ear.

Retention within the middle ear cleft is an unusual complication of T-tube insertion. A 40-year-old woman with Kartagener's Syndrome presented with hearing impairment in the right ear. She was found to have a previously inserted Goode T-tube lying within the middle ear behind an intact drum. She underwent successful removal of the T-tube via a myringotomy, and a new tube was re-inserted. Migration of a T-tube into the middle ear cleft should always be kept in mind in patients who present with otological symptoms and have a history of T-tube insertion, even in the presence of an intact drum.

Complementary and alternative medicine use among patients undergoing otolaryngologic surgery.

OBJECTIVE: The use of complementary and alternative medicine (CAM) may influence surgical care by inducing coagulopathies and interacting with other medication. We investigated the prevalence and pattern of CAM use in patients admitted to our department for elective otolaryngologic surgery. DESIGN: Cross-sectional survey. SETTING: Tertiary care referral centre in northeast Scotland. METHOD AND PATIENTS: All adult patients admitted for elective surgery, over a 14-week period from October 2005 to January 2006, were requested to complete an anonymous questionnaire. Data were analyzed with descriptive statistics using SPSS version 12 (SPSS Inc, Chicago, IL). MAIN OUTCOME MEASURES: To establish the prevalence of CAM use in patients admitted for surgery in our unit. Secondary measures included the type of CAM used, indications for use, perceived benefit, and communication with the family physician. RESULTS: Sixty-three percent (177 of 285) of the patient group had used CAM-36% in the preceding year. Popular remedies were cod liver oil, garlic, aloe vera, cranberry, echinacea, primrose oil, herbal vitamin supplement, and St. John's wort. Nonherbal therapies included massage, acupuncture, chiropractic, aromatherapy, reflexology, yoga, homeopathy, and osteopathy. Nine percent used CAM for their admission illness. Only 8% (15 of 177) found CAM ineffective. Only 76 of 177 (43%) had discussed their CAM use with their family doctor. CONCLUSION: Despite concerns over its safety, efficacy, and cost-effectiveness, the use of CAM is common among patients undergoing otolaryngologic and head and neck surgery. This has implications for all health care workers involved in their care, in particular the anesthetist and the surgeon. A detailed history of CAM use by patients should be taken and documented during the preoperative clerking.

Controlling MRSA in head and neck cancer patients: what works?

OBJECTIVE: We aimed to determine any beneficial effect from targeted surveillance, cohort nursing, and restricted health care worker access in controlling MRSA infection in patients undergoing surgery for head and neck cancer. STUDY DESIGN: Historical cohort study. SUBJECTS AND METHODS: In phase 1 data were gathered on MRSA-positive cases admitted from February 1, 2006 to February 28, 2007. In phase 2, from July 1, 2007 to January 31, 2008, eligible patients underwent screening swabs, cohort nursing, and restricted access. RESULTS: In the first phase, 24 patients developed MRSA infection out of a total of 84 eligible admissions. There were 31 eligible admissions during phase 2. None of them had known risk factors for MRSA as per Scottish Infection Standards and Strategy Group (SISS) guidelines. All screened patients were noncarriers of MRSA. Three patients out of this group subsequently developed MRSA during their hospital stay. There was a statistically significant drop in MRSA to 9.6 percent (3/31) during this phase compared to 28.5 percent (24/84) in phase 1. CONCLUSION: Head and neck cancer patients are at high risk of acquiring MRSA infection. Their targeted surveillance is unlikely to influence their MRSA infection rate. However, cohort nursing with restricted health care worker access may help control MRSA infection in them.

A review of nasal polyposis.

Nasal polyps are common, affecting up to four percent of the population. Their etiology remains unclear, but they are known to have associations with allergy, asthma, infection, cystic fibrosis, and aspirin sensitivity. They present with nasal obstruction, anosmia, rhinorrhoea, post nasal drip, and less commonly facial pain. Clinical examination reveals single or multiple grey polypoid masses in the nasal cavity. Computerized tomography allows evaluation of the extent of the disease and is essential if surgical treatment is to be considered. Management of polyposis involves a combination of medical therapy and surgery. There is good evidence for the use of corticosteroids (systemic and topical) both as primary treatment and as postoperative prophylaxis against recurrence. Surgical treatment has been refined significantly over the past twenty years with the advent of endoscopic sinus surgery and, in general, is reserved for cases refractory to medical treatment. Recurrence of the polyposis is common with severe disease recurring in up to ten percent of patients.