Microsuction aural toilet in ENT outpatients: a questionnaire to evaluate the patient experience.

Microsuction toilet of debris from the ear canal is a commonly performed procedure within the ENT outpatient clinic. This department has received two complaints from patients following microsuction aural toilet over the past year. These cases will be discussed. We wish to assess the frequency of side effects following aural microsuction in our department. A prospective questionnaire studied 164 patients undergoing aural microsuction over a 3 month period. From the total of 164 patients surveyed, only 74 (45%) did not report any adverse effects. Patients with mastoid cavities reported higher levels of vertigo when compared to those with normal ears (p < 0.001). A high proportion of patients have reported adverse side effects following aural microsuction. Medical staff should also be aware that certain patient subgroups are more prone to adverse effects. It would be appropriate to ensure that patients are counselled before suction takes place.

Myringoplasty: surgical outcomes and hearing improvement: is it worth performing to improve hearing?

The purpose of our study was to determine the success rate of myringoplasty in adults and children and to examine whether the hearing improvement is a potential indication for surgery. We performed a 6-year prospective audit study in a cohort of patients undergoing myringoplasty at the University Teaching Hospital, Department of Otolaryngology and Head and Neck Surgery. Two hundred and eleven patients who underwent myringoplasties were included in the study. All were performed by a postaural approach using autologous temporalis fascia and underlay technique. The total success rate, in terms of graft uptake at 3-6 months, was 91.5% and an overall hearing improvement was achieved in 91.5% of cases. This was statistically significant (P < 0.001). Only weak correlation was found between hearing improvement and age (Pearson's r = 0.175, P = 0.024), and there was no significant difference in hearing improvement across gender (P = 0.164), size (P = 0.198) or site (P = 0.447) of the perforation. Myringoplasty is an operation that can improve hearing in many cases independently of age, gender and the size and site of the perforation. Patients who undergo myringoplasty should be advised whilst been consented that there is a good chance of hearing improvement.

A study of chorda tympani nerve injury and related symptoms following middle-ear surgery.

This is a prospective study that looks into the prevalence of chorda tympani nerve (CTN) injury and related symptoms following varying degrees of trauma to the nerve during three common types of middle-ear operation: myringoplasty, tympanotomy and mastoidectomy. The number of patients with CTN-related symptoms varied widely between the three groups. Increased occurrence of the nerve related symptoms and a prolonged recovery time were observed in the tympanotomy group. Stretching of the nerve produced more symptomatic cases than cutting it in the myringoplasty and mastoidectomy groups. Recovery was complete in 92 percent of the symptomatic patients by 12 months. It is important to inform patients about the possibility of CTN injury during middle-ear operations, and it should also be emphasized that symptoms related to CTN injury can occur irrespective of the type of damage to the nerve.

Endoscopic stapling of post-laryngectomy neopharyngeal anterior diverticulum.

An anterior neopharyngeal diverticulum is a recognized cause of dysphagia following laryngectomy. It is easily treated by endoscopic stapling.

Schwannoma of the chorda tympani nerve.

We report a case of schwannoma of the chorda tympani. This is a very rare benign tumour and only five other cases have been found in the literature. This is the first case to mimic a cholesteatoma presenting as a pearly tumour in the postero-superior segment of the drum with aural discharge and conductive deafness. Diagnosis is usually by biopsy and treatment is surgical with preservation of facial and auditory function. A summary of the other presentations of this tumour together with a review of the histopathology of the disease is presented.

A study of postoperative fever following paediatric tonsillectomy.

The aetiology of post-tonsillectomy fever is obscure. Bacteraemia during surgery, anaesthetic agents and the inflammatory response of tissue to injury have been implicated. A prospective study was undertaken in 100 consecutive children to evaluate the occurrence and severity of fever in the 24 h after tonsillectomy and its relationship to bacteraemia during surgery and qualitative and quantitative cultures (colony counts) of organisms in tonsil core tissue. Fifty-four patients had a fever (> 37.5 degrees C) postoperatively, of whom, 30 had a fever greater than 38 degrees C. Blood cultures during tonsillectomy were positive in 22 patients. There was no statistically significant difference between the occurrence of fever and the techniques of tonsillectomy and haemostasis. There was also no association between positive blood, core or surface cultures and the incidence or severity of fever nor any association between colony count in core cultures and fever. Our results suggest that postoperative fever in the 24 h following tonsillectomy is not caused by infection.

Tuberculous otitis media--a case report.

Tuberculosis of the middle ear is a rare disease. Due to a change in the typical clinical signs in recent years and the fact that the index of suspicion is low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications. A case of tuberculous otitis media is reported, re-emphasising the fact that this entity must be considered in the differential diagnosis of persistent suppurative otitis media.

Otitis media with effusion: a disability or not?

Otitis media with effusion (OME) is a disease most commonly affecting the paediatric population. However, it is a condition that is also seen in adults and does lead to significant morbidity. We studied the effect of surgical treatment of OME in an adult population and found that the subjective relief of symptoms exceeded the objective audiometric gain. In children where subjective symptoms are perhaps more difficult to assess the clinician needs to beware of underestimating the effect of a hearing loss.

Audiometric changes in patients undergoing coronary artery bypass surgery.

The incidence of severe hearing loss following coronary artery bypass surgery has been estimated as one per thousand (Plasse et al., 1981). To evaluate the audiological changes that may be caused by the operation, audiograms were taken before and after surgery. The aim was to detect losses that were not necessarily severe and to examine the factors associated with any auditory insult. Patients without a past medical history of hearing problems or ototoxic drugs were examined on the day prior to the coronary bypass operation and audiometry carried out. Six days post-operatively they were re-examined and asked about their hearing and any tinnitus. Various operative details were taken and the post-operative drug record examined. Patients who were too ill for retesting, or who had been given sedative or ototoxic drugs or opiate analgesia, were dropped from the study. Twenty patients completed the tests. The whole procedure was repeated on a control group of 20 patients who were having thorocotomy but without being placed on a cardiopulmonary bypass. From the bypass sample of 40 ears, five ears (four individuals) had an individually statistically significant high-frequency hearing loss. The results show a statistically significant difference between the bypass group and the control group, with the bypass patients having worse threshold shifts following the operation. Discriminant analyses have shown that those patients suffering hearing impairment may be discriminated principally with four variables: the patient's age, minimum temperature and minimum blood pressure during the operation, and the time on bypass.

The cosmetic effects of submucous resection.

A prospective assessment of the complications of submucous resection is presented. Preoperative photographs were taken and a post-operative assessment was carried out at a minimum time of 2 years by questionnaire and photographs. No examples of significant cosmetic changes were found.

Tonsillectomy haemostasis: diathermy or ligation.

A retrospective and prospective study has been carried out to assess the morbidity associated with the techniques of diathermy and ligation in controlling tonsillectomy haemorrhage. No difference was found in the incidence of haemorrhage between the two techniques. The use of diathermy cuts the operation time by 26%, and has no increase in morbidity.

Objective tinnitus and tympanic membrane displacement.

A young girl with objective tinnitus is presented. Using tympanic membrane displacement, the probable origin of the tinnitus has been demonstrated. The patient has responded well to treatment with a tinnitus masker.

High-frequency monitoring using an electrostimulation audiometer.

Electrostimulation audiometry can provide high-frequency bone-conduction threshold measurements. To evaluate the use of such an audiometer in monitoring hearing, the following areas were investigated. (1) The variability and repeatability of threshold measurements. (2) To see if the instrument could be used on the ward where the patient would have to wear ear plugs to attenuate background noise, the effect of occluding the ears was assessed. (3) The applicability of the instrument to the range of patients in whom monitoring would be appropriate, specifically the relationship between the patient's age and the effective upper frequency limit of the audiometer. The data showed a variability in threshold measurement that is quite comparable with that obtained with conventional audiometry but which became smaller at frequencies of 12 kHz and higher. There was no overall effect on the threshold of occluding the ears, which meant that the instrument can be used to monitor a non-isolated environment such as a ward. The effective cut-off frequency was about 9 kHz for patients aged 55 years, and so the use of an electrostimulation audiometer to monitor high-frequency auditory thresholds is restricted to younger patients.

The treatment of laryngeal stenosis using the CO2 laser.

Conventional open treatment for laryngeal stenosis involves major surgery. Seventeen patients with various pathologies, who needed tracheostomy to relieve their laryngeal stenosis, have been assessed following endoscopic treatment with the CO2 laser. Following an initial direct laryngoscopy, 3 of the patients were considered to be unsuitable for laser treatment. The remaining 14 patients had the stenosed area excised until it was felt that the airway was sufficiently patent to allow closure of the tracheostomy. Eight of the patients were successfully decannulated. The CO2 laser may be used endoscopically to treat certain patients with laryngeal stenosis, who would otherwise require open operation or a permanent tracheostomy.

Bilateral oval window fistulae with recurrent meningitis.

A case of recurrent meningitis due to a congenital stapes footplate defect is reported. This is the first case to be reported in which a bilateral defect has been clearly demonstrated. A suggestion is made that any future cases which have a defect on one side, might benefit from a prophylactic exploration on the seemingly uninvolved ear, providing that these cases are shown to have a bilateral total sensori-neural hearing loss.