Simple new method of protecting the septum during oxygen delivery via a nasal canula.

Epistaxsis and crustation are common problems associated with long-term use of oxygen through nasal prongs in patients suffering from chronic obstructive pulmonary disease. The nasal prong can cause direct trauma to the septal mucosa. We describe a simple solution to this problem with use of the disposable ear tip used in tympanometry.

Feasibility of otoacoustic emissions as a hearing screen following grommet insertion.

Following grommet insertion, it is important to establish that there is no underlying sensorineural hearing impairment. In this hospital, approximately 1000 grommet insertions are performed each year, thus generating a heavy workload of review appointments for ENT and audiology. The present study investigates the efficacy of performing evoked otoacoustic emissions screening on 108 children when they were ready to leave the hospital following grommet insertion. Bilateral normal otoacoustic emissions were recorded in 32% (35 children), although 99% (105) of the 106 children attending the outpatient review appointment had normal hearing sensitivity. If normal hearing thresholds were established immediately following surgery, it can be argued that this obviates the need for an outpatient review appointment; however, in this study only one-third of children could be discharged after surgery. Otoacoustic emissions therefore does not represent an effective screen at this stage.

Tympanosclerosis and mini grommets: the relevance of grommet design.

Fifty children with otitis media with effusion undergoing grommet insertion had into one ear a Mini-titanium grommet inserted and into the other ear a Mini-teflon grommet. Post-operative follow-up until after extrusion of the grommets demonstrated only a small difference between the extrusion times of the two grommets (a significant difference of 41 days) and no difference in the degree of tympanosclerosis seen with each grommet. We propose that the mass of a grommet appears to play less of a role than has previously been suggested in the pathogenesis of tympanosclerosis following grommet insertion and that duration of intubation may be the most significant factor.

Acquired involution of the maxillary antrum.

Maxillary sinus shrinkage can occur secondary to acquired benign osteomeatal disease. This may be associated with an external deformity and sinus wall sclerosis.

The mini-grommet and tympanosclerosis: results at two years.

One hundred and sixteen children with otitis media with effusion (OME) underwent surgery with grommet insertion. A conventional Shah grommet was used in one ear, and a Mini-Shah grommet in the other. Final review of the subjects two years after surgery revealed a significantly lesser degree of tympanosclerosis in the ear into which the Mini-Shah grommet had been inserted. This benefit might have resulted from the lesser mass of the mini-tube or its shorter duration in situ.

Fenestration and occlusion of the posterior semicircular canal for benign positional vertigo.

Benign positional vertigo is a potentially disabling condition characterized by episodic vertigo following certain provocative head movements. In most patients it is self limiting; however, in a few it may prove intractable, causing considerable social morbidity. In these patients surgery may be considered. Surgery previously involved section of the vestibular or singular nerves, involving a significant risk to hearing and to the facial nerve. Ablation of the labyrinth may even be considered. The new surgical technique of occlusion of the posterior semicircular canal has proved to be curative in most patients with benign positional vertigo with little risk of hearing. This paper describes our experience of fenestration and occlusion of the posterior semicircular canal in four patients.

The mini-grommet and tympanosclerosis.

One hundred and sixteen children with otitis media with effusion underwent myringotomy and insertion of a conventional pattern of Shah grommet in one ear and the much smaller Mini Shah grommet in the other. Close observation post-operatively determined the comparative rate of extrusion, recurrence of effusion, and of onset and degree of tympanosclerosis. At one year review, the Mini Shah shows a significantly earlier extrusion and a greater tendency to recurrence of otitis media with effusion. However, this is compensated by a decreased incidence of tympanosclerosis and reduced severity in those affected. This tends to support the view that shear forces produced by heavier patterns of ventilation tube promote tympanosclerosis.