Study of microbial spread when using multiple-use nasal anaesthetic spray.

BACKGROUND: Current economic constraints have led to the emergence of reusable anaesthetic sprays with replacement nozzles (Xylocaine) as an alternative to disposable anaesthetic solutions (Co-phenylcaine) for rhinological procedures. The former costs 213.84 per year vers12,047.69 for the latter, at equivocal doses. However, research regarding the sterility of such instruments is limited. The aim of this in vitro study was to determine whether bottles of Xylocaine could pose a risk of cross-infection to patients. METHODS: Two techniques were used. The first was to introduce nozzles into methylene blue and fluorescein dyes, and then analysing the anaesthetic solutions using spectrophotometry for assessment of colour change indicating retrograde contamination. The second method involved spraying Xylocaine into cultures of Staphylococcus aureus with concurrent nozzle changes. This was repeated over a 36-day-period. Sterility checks were performed on the Xylocaine before and after inoculation into the culture. RESULTS: None of the anaesthetic solutions showed the presence of dyed saline following spectrophotometric analysis. No S. aureus was isolated from any of the 30 spray bottles cultures over the 36-day trial period. CONCLUSION: It was demonstrated that using the Xylocaine spray with disposable nozzles for each patient should not pose a cross infection risk to patients.

Conservative management of epistaxis: are we putting patients at risk of developing venous thromboembolic complications?

A retrospective study of 1585 patients, admitted with epistaxis to a busy District General Hospital in the United Kingdom between 1990 and 2000, was undertaken in order to identify the relationship between hospital admission for epistaxis and the development of a venous thromboembolic event. Only one person (0.06%) developed pulmonary embolus (PE) within 6 weeks of hospital admission. No one developed a deep vein thrombosis (DVT). This compares with the incidence of DVT and fatal PE in the general population. In our study population, the incidence of both PE and DVT was found to be no greater than that seen within the community and certainly less than the incidence seen within a group of high risk hospitalised patients. We conclude that hospital admission for epistaxis does not place the patient at increased risk of thromboembolic disease.

Avoiding alar necrosis with post-nasal packs.

Foley's catheter is used for post-nasal packing in severe epistaxis. Various methods have been described for securing the catheter in position, all of which can be associated with patient discomfort, risk of alar necrosis or unsightliness. We describe a new method to secure the Foley's catheter without these problems. The ribbon gauze used for anterior nasal packing is tied over the catheter in multiple knots to secure it in place. This has been successfully tried on over 50 patients.

Lobular capillary haemangioma of the nasal vestibule: a rare entity.

The authors report a case of an 8-year-old boy with lobular capillary haemangioma (LCH) of the nasal vestibule presenting with nasal blockage, nasal discharge and epistaxis. LCH of the nasal vestibule is rarely reported in the English literature, and the authors feel that it should be considered in the differential diagnosis of lesion of the nasal vestibule. Unnecessary investigations could be avoided if its diagnosis is considered, especially in children.

Magnetic nasal foreign bodies: a result of fashion mania.

The fashion of body piercing among adults has encouraged children to have similar procedures or imitate them by applying small magnets to sustain the jewelery used in piercing in position [Emerg. Med. J. 19 (2002) 71]. We present cases of children who have placed magnets on their nasal alae that became misplaced on to the nasal septum causing severe pain and in some cases nasal bleeding and septal perforation. We describe management of these cases.

Delivery of nasal drops to the middle meatus: which is the best head position?

BACKGROUND: Chronic sinusitis and intranasal polyps require long-term topical drug therapy. The issue of drug delivery to the critical area of the middle meatus is rarely addressed. AIM: The aim of this study was to compare the delivery of drops to the middle meatus using four different head positions (Mecca, Mygind, Ragan and Head back). The study also assessed the discomfort with each position whilst administering the nasal drops. METHODS: Nine nostrils in five healthy volunteers were studied to compare the delivery of drops to the middle meatus using the four different head positions. A neurosurgical patty was placed under direct vision in the middle meatus using a rigid nasendoscope. Six drops of dyed-saline were administered into each nostril. Upon removal, a quantitative assessment was made of the amount of dye absorbed and discomfort assessed. The direction of flow of the nasal drops in the nose was also demonstrated. RESULTS: The 'Mygind' and 'Ragan' positions were superior to the 'Mecca' and 'Head back' positions in delivery of drops to the middle meatus. The 'Mecca' position was the most uncomfortable. CONCLUSION: We recommend that the 'Mygind' or 'Ragan' position should be used for nasal drop administration.

Hairy polyp of the oropharynx in a newborn: a case report.

An unusual case of an oropharyngeal mass in a neonate causing intermittent airway obstruction during the first 24 hours following delivery is presented. This mass was confirmed to be a hairy polyp. We discuss the incidence, histology and peri-operative management of this unusual lesion.

How I do it; securing a full thickness skin graft.

The authors present a novel way of securing a full thickness skin graft (Wolfe graft) that we believe is not only time saving but also helps to create a dressing that exerts an equal pressure over all areas of the graft.

Short-term and long-term physical effects of exposure to CS spray.

CS gas (2-chlorobenzylidene malonitrile) is widely used in an incapacitant spray that causes intense lacrimation, blepharospasm and burning sensations in the throat and nose. Questions have been raised about its safety. We obtained information on short-term and long-term symptoms, and performed ear, nose and throat examinations and respirometry at 8-10 months, in 34 young adults who had been exposed to CS spray in a confined space during a confrontation with police. The group was subdivided into those who had been sprayed directly on the face (n=10) and those exposed indirectly. At one hour, all but 2 individuals still had symptoms; respiratory and oral symptoms were significantly more prevalent in the directly exposed group. At one month, only oral symptoms were significantly more prevalent. At 8-10 months, symptoms were still reported but there were no differences between the groups and clinical examinations revealed no specific abnormalities. There was no convincing evidence of long-term physical sequelae from exposure to CS spray.

Nasogastric tube insertion using flexible fibreoptic nasoendoscope.

The insertion of a nasogastric tube, especially a fine bore feeding tube, can occasionally be problematic because of an anatomical variation or pathology. A method of passing an nasogastric tube under direct vision using a flexible fibreoptic nasoendoscope introduced through the nostril is described, which is reserved for cases where traditional methods of insertion failed.

Intranasal delivery of drugs to eustachian tube orifice.

BACKGROUND: Intranasal medication administration which aims to deliver to the eustachian tube orifice has been adopted for the management of a number of otological conditions, acting via a reduction in tubal oedema and improved ventilation. Evidence for the optimal head position for such drug administration is limited. We compared four different positions and also assessed spray versus drop formulation, to determine optimal delivery conditions. METHODS: Prospective, five-period, cross-over study using methylene blue dyed saline in a drops or spray container. Five healthy volunteers tested the Mygind, Ragan, Mecca and 'head back' head positions. Nasal spray drug delivery in the most effective head position was then compared with drops drug delivery (administered in the head back position). Intranasal delivery was assessed photographically using a 30° rigid naso-endoscope. RESULTS: Maximal nasal drops delivery was achieved with the Mygind and Ragan positions. Drops were more successful than spray in reaching the eustachian tube orifice. CONCLUSION: The Mygind and Ragan positions are best for eustachian tube orifice drug delivery, and drops preparations are better than spray preparations.

Massive recurrent epistaxis from non-traumatic bilateral intracavernous carotid artery aneurysms.

Recurrent epistaxis may rarely follow traumatic intracavernous carotid artery aneurysm. This occurs nearly always after head injury and is usually associated with fracture of the skull base. Severe torrential epistaxis due to non-traumatic intracavernous carotid artery aneurysm is extremely uncommon and potentially fatal, with only a few cases having been reported in the literature. We present the case of a 23-year-old female with a history of recurrent severe epistaxis and otalgia due to bilateral intracavernous carotid artery aneurysms, illustrating the diagnostic difficulties. The radiological investigations and the management of the patient are discussed and relevant literature is reviewed.

Are nasal fractures being referred appropriately from the accident and emergency department to ENT?

OBJECTIVE: Nasal trauma does not always require ENT clinic follow-up. We assess the appropriateness of referral to the ENT department from A&E of suspected nasal fractures. METHOD: The 342 case notes of patients referred to ENT from A&E with suspected nasal fractures were reviewed. The patients were divided into groups depending on whether or not they showed clinical features in A&E. RESULTS: Patients showing clinical features in A&E initially were significantly [P < .005] more likely to attend their clinic appointment than those without clinical features. They were also significantly more likely [P < 0.001] to undergo surgical correction of their nose. CONCLUSIONS: Suspected nasal fractures following trauma should be referred to ENT only if they show clinical features on presentation to A&E. For patients developing clinical features over the next 3 weeks a telephone number should be given to the patient for rapid access to the ENT clinic.

Neuromuscular hamartoma of the cochlear nerve: a rare occurrence in the internal auditory meatus.

The authors present a case of neuromuscular hamartoma of the cochlear nerve, an unusual occurrence in the internal auditory meatus (IAM). A review of the literature shows no previous report of neuromuscular hamartoma of the cochlear nerve. This tumour was clinically and radiologically difficult to distinguish from acoustic neuroma. It is important to consider the diagnosis of these rare small tumours pre-operatively, as it may be appropriate to manage this conservatively.