Operative management of external auditory canal cholesteatoma: case series and literature review.

OBJECTIVES: To describe the clinical features of external auditory canal cholesteatoma, and to assess the outcome following bony meatoplasty with tragal cartilage and perichondrium graft repair. METHODS: A retrospective review was carried out, comprising all patients with external auditory canal who presented between January 2007 and December 2011. Patients underwent pre-operative audiometry and computed tomography imaging of the temporal bones, before undergoing bony meatoplasty via a postauricular incision. Pre- and post-operative comparisons were made of patients' otological symptoms and the otoscopic appearance of the external ear canal. RESULTS AND CONCLUSION: Eight patients were included in the analyses. The median age of patients was 46.5 years (range 14­68 years), with a male to female ratio of 1:1. The median length of follow up was 16 months. The most common presenting features were unilateral otalgia and purulent otorrhoea. All patients had relatively advanced disease at presentation, with erosion of the temporal bone. All patients underwent bony meatoplasty via a postauricular approach to eradicate the disease. Bony meatoplasty was successful in the definitive management of external ear canal cholesteatoma.

Management of serum calcium levels in post-thyroidectomy patients.

Otolaryngologists are increasingly performing thyroid surgery and are responsible for optimising parathyroid function postoperatively. The aim of this study was to establish an evidence-based algorithm for the management of postoperative calcium levels and to try and answer some relevant postoperative management issues. These include the following: (1) What is the risk of hypocalcaemia both temporary and permanent? (2) When should calcium replacement be commenced and in what form? (3) What is the best method for calcium replacement without suppressing a recovering parathyroid? (4) How to identify recovering parathyroid function if the patient is already on calcium replacement? A systematic review of the literature was carried out supported by a retrospective analysis of postoperative calcium levels obtained from clinical records of patients undergoing thyroidectomy under our care (n = 167). We present an evidence based, user-friendly algorithm for the management of the serum calcium in patients undergoing thyroid surgery.

Sino nasal assessment questionnaire, a patient focused, rhinosinusitis specific outcome measure.

It is becoming increasingly important for clinicians to be able to demonstrate the effectiveness of their interventions. We have developed a rhinosinusitis--specific outcome measure (SNAQ-11) that avoids the shortcomings of the existing tools. This paper compares its use with the widely used Sinonasal Outcome Test (SNOT-20). We carried out a prospective study that involved forty patients undergoing endoscopic sinus surgery. Their SNAQ-11 and SNOT-20 scores were compared pre and post operatively. We also recorded individual symptom scores pre and post operatively in order to study the impact of surgery. The study shows a larger change in the postoperative SNAQ score compared to that in SNOT-20 (21% c.f. 11%) Although the pre and post-op changes in SNOT-20 are significant at the p = 0.005 level, the changes in the SNAQ-11 are highly significant at the p = 0.0001 level. Furthermore we have statistically confirmed that the change seen with SNAQ-11 is larger in relation to the variation in change as compared with SNOT-20 (-1.08 c.f. -0.59). Our results show that SNAQ-11 is a valid and highly relevant rhinosinusitis outcome tool. The results also confirm that Endoscopic Sinus Surgery seems especially effective at addressing nasal obstruction, congestion and facial pain/pressure, fair at anterior nasal discharge, sneezing, hyposmia and sleep disturbance and poor for post nasal drip, cough and earache.

Osseous haemangioma of inferior turbinate.

We present a case of osseous haemangioma arising within the inferior turbinate.

A new approach to improving illumination in the nose during endonasal surgery.

Despite improvements in light sources the problem of illumination during endonasal surgery persists. This is particularly so in the presence of blood which absorbs light and renders the operative field dark as a consequence. This paper describes a series of in vitro experiments that show how improved illumination is possible using readily available, inexpensive, sterilisable and flexible materials. The hypothesis tested was that white coloured materials, when placed into the nasal cavity during endonasal surgery, improve illumination of the operative field by reflecting light onto the area of surgical interest. This hypothesis was tested with the use of a light proof box into which were introduced blood coloured and reflective materials. The light reflected back from a fixed blood coloured surface within the box was measured. The introduction of white materials into the box provided greater illumination than blue or foil surfaces.

Well-differentiated liposarcoma of the hypopharynx.

We present a case of well-differentiated liposarcoma of the hypopharynx in a 51-year-old male, with a review of the literature of this very rare condition.