Ten years of deep neck space abscesses.

BACKGROUND: The incidence of deep neck space abscesses, which can result in significant morbidity and mortality, is rising. The aetiology is thought to be dental. However, this study suggests a reduction in tonsillectomies may be associated with the rise. METHOD: In a retrospective cohort study, patients were identified by a clinical code within one hospital over 10 years. Evidence of preceding infection source, management, lifestyle risks, comorbidities and demographics were extracted. RESULTS: Fifty-two patients were included: 23 (44 per cent) had concurrent or recent tonsillitis; 11 (21 per cent) had poor dental hygiene; 22 (42 per cent) were smokers; and 9 (17 per cent) had diabetes. The incidence of deep neck space abscess cases increased from 1 in 2006, to 15 in 2015 (correlation value 0.9; p = 0.00019). CONCLUSION: The incidence of deep neck space abscess cases is increasing. Risk factors include tonsillitis, smoking and dental infection. This paper adds to the growing evidence that deep neck space abscesses are increasingly related to tonsillitis, and questions whether the threshold for tonsillectomy has been raised too high.

The experiments behind the Tullio phenomenon.

BACKGROUND: Professor Pietro Tullio was a director at the Laboratory of Experimental Physiology in Bologna during the early twentieth century. His experimental studies resulted in the description of the Tullio phenomenon, which is characterised by sound-induced vertigo and/or eye movements. OBJECTIVE: The experimental studies behind his contribution to vestibular physiology are described within this paper, as are some of the further developments that have been made.

Cochlear implant electrode insertion: in defence of cochleostomy and factors against the round window membrane approach.

INTRODUCTION: The round window membrane (RWM) is an increasingly popular route for electrode insertion in cochlear implantation especially for hearing preservation. Limitations to this route include anatomical, physiological, and surgical aspects. The established soft-tissue cochleostomy route for electrode insertion is thought to place the basilar membrane and spiral ligament at risk. However, the mammalian model response to soft-tissue cochleostomy has not yet been quantified. METHODS: Firstly, an on-line literature search was conducted to gather evidence of the anatomical and physiological functions of the RWM and adjacent structures. Secondly, experimental guinea pigs underwent left soft-surgery cochlestomy. Four weeks post-operatively they were euthanased and the cochlea's harvested for histology. Surgical damage to the cochlea and auditory neurons was assessed. RESULTS: The literature review with regard to the RWM anatomy revealed evidence for difficulty in approach/visualization, possible absence, and impedance of electrode insertion by the hook region. It also has a number of higher functions including immune defence and absorption/secretion of molecules. Experimental cochlea's 4 weeks post-soft-tissue cochleostomy showed only mild and localized inflammatory response adjacent to the scala tympani cochleostomy site. There was no spiral neuronal ganglion loss. CONCLUSIONS: The RWM route may be compromised or absent. Electrode insertion via the RWM could interfere with its higher functions. Mammalian soft-tissue cochleostomy has been shown to elicit a limited tissue response and does not reduce the number of cochlear spiral ganglion neurones. It should therefore remain within the hearing implant surgeon's armamentarium.

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.

Non-thyroid neck lumps: appraisal of the role of fine needle aspiration cytology.

To compare the non-diagnostic rate of fine needle aspiration cytology (FNAC) of non-thyroid neck lumps performed under ultrasound (US) guidance against non-guided FNAC (performed in outpatient clinic). Final histology results were compared with cytological diagnosis. We performed a retrospective study of 625 patients identified as having undergone FNAC of non-thyroid neck lumps from the pathology/radiology databases over a 3 year period. A total of 396 patients underwent non-ultrasound guided FNAC (12 excluded). 34% of patients had a non-diagnostic sample. A total number of 229 patients underwent ultrasound guided FNAC with a non-diagnostic rate of 12%. The Chi-squared test showed a significant difference (P < 0.001). FNAC results were compared with definitive histology in 238 patients. Sensitivity was 92% and specificity was 90%. US-guided FNAC resulted in a lower non-diagnostic rate. FNAC was highly sensitive for diagnosis of malignant lumps but less good at confirming a lump to be benign.