Outcomes of submandibular duct relocation: a 15-year experience.

Drooling is common in patients with neurological disability and a major factor affecting quality of life. Management of this problem is best carried out by a team approach using surgical and non-surgical methods. Submandibular duct relocation is a commonly performed procedure with low complication rate. This procedure has been carried out in 56 patients over the last 14 years at the Belfast City Hospital by the senior author. All the patients underwent physiotherapy for six months before they were selected for surgery. All the patients were over five years of age and most had severe neurological impairment. For the purposes of this study, all the patients were followed by a questionnaire regarding symptomatic improvement, parent satisfaction and complication rate. All case notes were also reviewed retrospectively. Parental satisfaction was high and drooling was significantly reduced in 49 cases. The main complication was ranula formation seen in five cases. The most significant area of parental concern was post-operative pain. It is important to counsel the parents regarding the post-operative pain relief as well as failure rate of the procedure. It can be concluded that this procedure is a safe and highly successful procedure, which significantly improves the quality of life.

Oral appliances for the management of severe snoring: a randomized controlled trial.

The aim of this randomized controlled trial was to assess the effectiveness of a mandibular advancement appliance (MAA) in managing severe snoring. Twenty-eight adults with severe snoring and normal overnight oximetry were recruited from sleep disorder clinics. A maxillary placebo appliance and a MAA were worn by each subject for a period of 4-6 weeks each. Questionnaires at baseline and after each appliance period assessed bed partners' reports of snoring severity (loudness and number of nights per week), and patients' records of daytime sleepiness. Twenty-five subjects completed the entire trial. The MAA was significantly more effective than the placebo in reducing the frequency and loudness of snoring, the reported daytime sleepiness and the frequency of morning tiredness. Excessive salivation was the most commonly reported complication. It was concluded that the custom-made MAA was significantly more effective than the placebo in managing the main symptoms of severe snoring. However, not all subjects' partners reported an improvement with the MAA, with 84 per cent reporting a reduction in snoring loudness and 76 per cent reporting snoring on fewer nights per week.

Subcutaneous emphysema as a complication of tonsillectomy.

Subcutaneous emphysema occurs when air is introduced into the tissues. This can happen as a complication during, or immediately after surgery. It has rarely been described after tonsillectomy. Definitive treatment will depend on the cause. We report two cases of subcutaneous emphysema following tonsillectomy.

Uvulopalatopharyngoplasty for snoring: the Belfast experience.

We have studied thirteen patients to assess the efficacy of uvulopalatopharyngoplasty on snoring and on oxygen desaturation during sleep. Pre- and post-operative overnight pulse oximetry studies were performed and the patients were divided into snorers and those with obstructive sleep apnoea on the basis of the preoperative test. Uvulopalatopharyngoplasty did not result in a significant change in the number of oxygen saturation dips in either snorers or those with the obstructive sleep apnoea syndrome. Subjectively, 85% (11/13) of patients reported good or excellent improvement in snoring following surgery.

Bilateral vocal cord paralysis in Williams syndrome.

Williams syndrome was first described in 1961 (Williams et al. 1961) and is a well-recognised clinical syndrome characterised by growth deficiency, learning difficulties and a typical facies. We describe a 9-year-old girl with classical features of Williams syndrome who presented with acute vocal cord paralysis for which no other cause was found.

The influence of beta-adrenoceptors on nasal mucosal function.

The aim of the study was to elucidate the role of beta-adrenoceptors in normal human nasal mucosa. In two studies, beta-receptor function was tested by the application of agonists and antagonists. Measurements of nasal secretion and nasal peak expiratory flow were performed at 4-min intervals, during 12 min of rest, pre- and post-treatment, 12 min of exercise and 20 min of recovery. In Study 1, placebo was compared with 100 micrograms salbutamol and 2 mg propranolol. Neither placebo nor 100 mg salbutamol affected nasal secretion production at rest, but propranolol caused a transient significant increase (p < 0.05). Exercise significantly increased secretion production in all three treatment groups (p < 0.05). Nasal peak expiratory flow was not altered at rest, but increased significantly (p < 0.05) during exercise in the three treatment groups. In Study 2 placebo was compared with 200 mg salbutamol, 80 micrograms isoprenaline and 2 mg atenolol. Secretion production was not altered at rest by any treatment and increased during exercise in all four (p < 0.05). There was no significant difference between weights of secretions produced between any of the treatment groups during exercise. Salbutamol significantly decreased nasal peak expiratory flow at rest compared with placebo (p < 0.05). During exercise nasal peak flow increased in all groups, but peak exercise values were significantly reduced by both salbutamol and isoprenaline (p < 0.05). Atenolol appeared to have no effect on nasal peak expiratory flow.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of methacholine on nasal transmucosal potential difference in normal human subjects.

This study was proposed to test the hypothesis that the parasympathetic system might attribute to the transmucosal potential difference. In a double-blind, placebo-controlled study six volunteers had nasal transmucosal potential difference (NTPD) recorded at 4-min intervals during 12-min periods of rest, before and after treatment, as well as during exercise and recovery. Application of placebo did not significantly alter NTPD at rest. There was a significant rise during exercise (p < 0.05). The application of methacholine significantly increased NTPD at rest (p < 0.01); there was a further rise during exercise (p < 0.02). We conclude that parasympathetic stimulation can increase the transmucosal potential difference.

Hearing loss in diabetics.

The relationship between diabetes and sensorineural hearing loss has been disputed. This study compares 44 insulin-dependent diabetics with 38 age and sex matched controls. All had pure tone and speech audiometry performed, with any diabetic showing sensorineural deafness undergoing stapedial reflex decay tests. In 14 diabetics stapedial reflex tests showed no tone decay in any patient, but seven showed evidence of recruitment. Analysis of variance showed the diabetics to be significantly deafer than the control population. The hearing loss affected high frequencies in both sexes, but also low frequencies in the male. Speech discrimination scores showed no difference. Further analysis by sex showed the males to account for most of the differences. Analysis of the audiograms showed mostly a high tone loss. Finally duration of diabetes, insulin dosage and family history of diabetes were not found to have a significant effect on threshold.

The effects of diuretics on nasal transmucosal potential difference.

The effects of application of frusemide, amiloride and bumetanide on nasal transmucosal potential difference (NTPD), at rest and during exercise, were studied in 8 normal subjects. In a double-blind placebo controlled study, 8 volunteers had NTPD recorded at 4-min intervals during 12-min periods of rest, before and after treatment, during 12 min of exercise, and recovery. Application of placebo, frusemide and bumetanide did not significantly alter NTPD at rest. Amiloride caused a significant reduction (P less than 0.025). During exercise there was a significant rise in NTPD with placebo (P less than 0.05), frusemide (P less than 0.05) and amiloride (P less than 0.05). There was no increase in NTPD during exercise with bumetanide.

Young's procedure in the treatment of epistaxis.

Intractable epistaxis associated with septal perforation is a difficult problem to treat, particularly if nose-picking appears to be associated. Two such cases are presented in which Young's procedure of nasal closure was used to prevent epistaxis. Although the procedure was fully successful in only one patient, we feel the procedure has a part to play in the management of such cases of epistaxis.

Advice to candidates sitting the Final Fellowship Examination.

This paper is intended to provide guidance to candidates sitting the Final Fellowship Examination in Otolaryngology of the Royal College of Surgeons of Edinburgh. Although some of the advice given is specific to the Fellowship in Otolaryngology of that College, much of it is of relevance to any examination.

Acute mastoid abscess and cholesteatoma.

A 10-year review of acute mastoid abscess treated surgically in Belfast revealed a total of 24 cases, 12 of which were found to have an underlying cholesteatoma. The surgical management of these 12 cases is outlined but despite a desire to maintain an intact canal wall, 9 of them to date have ended up with an open cavity. The danger of conservative management and the possible association between acute mastoid abscess and cholesteatoma, especially in developed countries, is stressed.

Congenital syphilitic deafness--a further review.

Initial optimism about the successful outcome of treatment of congenital syphilitic deafness with ampicillin and steroids has always been tempered with an awareness of the uncertain long-term results. This paper is a review of 16 patients treated with various combinations of ampicillin and steroid; these have been followed up for periods of five to 14 years. Ampicillin alone does not prevent progressive hearing loss in the majority of patients. Ampicillin combined with prednisone, or with prednisone and ACTH, has preserved the hearing in all but two ears which had useful hearing before treatment. The fact that the hearing in many of these ears, although maintained, continues to fluctuate still gives cause for concern.