Laryngopharyngeal reflux and primary snoring: a pilot case-control study.

STUDY OBJECTIVES: Laryngopharyngeal reflux has been implicated as a causative factor in the aetiology of sleep related breathing disorders. However there are no reports on the association of this disorder and primary snoring in the absence of obstructive sleep apnoea. This study was undertaken to investigate any link between primary snoring and the presence of laryngopharyngeal reflux. METHODS: A matched case-control study was performed in a district general Ear Nose Throat outpatient population in the United Kingdom. Twenty six patients referred for snoring without sleep apnoea (cases) were individually matched for gender, body mass index and age, to 26 patients referred for other otorhinolaryngological complaints (controls). Snoring was not an exclusion criterion for the controls. Exclusion criteria for both groups were previous referral or treatment for snoring and/or sleep apnoea, nasal obstruction symptoms (as a potential cause of snoring), and known history of gastrooesophageal reflux with medical treatment longer than two months. The main outcome measure was prevalence of laryngopharyngeal reflux based on the Reflux Symptom Index score. RESULTS: Patients seeking medical advice for primary snoring are fourteen times more likely to report Reflux Symptom Index scores of more than 13 than controls. CONCLUSIONS: Laryngopharyngeal reflux may also be implicated in the pathogenesis of primary snoring in the absence of sleep apnoea. This constitutes 3b level of evidence.

One stop rectal bleeding clinic: the coventry experience.

Among most patients attending a rectal clinic, rectal bleeding is a common presenting feature. In most patients, the cause is attributed to a benign lesion. In a small percentage, the cause is neoplastic, and for this reason, rectal bleeding merits further study. Left-sided tumors account for the majority of these tumors and are within the reach of a flexible sigmoidoscopy. This study aimed at examining the diagnostic performance of the one stop rectal clinic in Coventry. Between November 2001 and May 2002, 250 consecutive patients were seen in the one stop rectal bleeding clinic of a tertiary referral hospital. Patients were asked of the nature of rectal bleed and altered bowel habits and were examined by digital rectal examination, with a proctoscopy and rigid sigmoidoscopy before either a full colonoscopic examination or flexible sigmoidoscopy with a completion Barium enema. During the study period, colorectal cancer was detected in 4 patients (1.6%), adenomatous polyps in 36 patients (14.4%), and ulcerative colitis in 8 patients (3.2%). In 98 patients (39.2%), no abnormality was present, and in the remaining patients, diverticulosis (n = 60; 24%) and hemorrhoids were present (n = 44; 17.6%).

The future of early disease detection? Applications of electronic nose technology in otolaryngology.

INTRODUCTION: Recent advances in electronic nose technology, and successful clinical applications, are facilitating the development of new methods for rapid, bedside diagnosis of disease. There is a real clinical need for such new diagnostic tools in otolaryngology. MATERIALS AND METHODS: We present a critical review of recent advances in electronic nose technology and current applications in otolaryngology. RESULTS: The literature reports evidence of accurate diagnosis of common otolaryngological conditions such as sinusitis (acute and chronic), chronic suppurative otitis media, otitis externa and nasal vestibulitis. A significant recent development is the successful identification of biofilm-producing versus non-biofilm-producing pseudomonas and staphylococcus species. CONCLUSION: Electronic nose technology holds significant potential for enabling rapid, non-invasive, bedside diagnosis of otolaryngological disease.

Tragal cartilage harvesting and 'in the ear' earphones: a pilot study.

'In the ear' headphones are held in position by the cartilaginous skeleton of the pinna. The tragus is an important part of this skeleton and plays a significant role in holding these devices in place. We designed a retrospective case-control study to determine whether the harvesting of tragal cartilage had any effect on the ability to wear 'in the ear' earphones. Fifty patients who had undergone ear surgery requiring harvesting of tragal cartilage, along with 50 age-matched controls who had undergone similar procedures without tragal cartilage harvesting, were sent a questionnaire about their experiences with 'in the ear' earphones both pre- and post-operatively. Ten of the 12 patients in the tragal harvesting group who had used earphones pre- and post-operatively had had problems with earphones post-operatively, which in eight cases were due to pain or the devices falling out. Of the 12 respondents in the non-tragus group, only one had similar problems (p<0.05). Tragal harvesting may affect the ability of patients to wear certain types of headphones post-operatively and this should be discussed pre-operatively with the patient.

Antiphospholipid syndrome: a series of surgical emergencies and the current evidence for its management.

It is generally accepted that antiphospholipid syndrome remains a major medical problem characterised by hypercoagulability, arterial and venous thrombosis and thrombocytopenia. It is unclear how best to treat these patients should they require emergency surgery. If a lupus anticoagulant is present, hypercoagulability may occur de novo but surgical interventions along with sepsis are two important predisposing factors. We describe three patients with primary antiphospholipid syndrome and discuss the implications for surgery.