Squeeze bottle versus syringe nasal saline irrigation for persistent allergic rhinitis - a randomized controlled trial.

BACKGROUND: Nasal irrigation is widely used as an adjunctive treatment for allergic rhinitis. There is little evidence regarding the efficacy of the devices used in this procedure. The objective of this study was to evaluate the efficacy of the squeeze bottle nasal saline irrigation in persistent allergic rhinitis patients compared with a syringe. METHODOLOGY: We included patients between 18- and 60-years old presenting with persistent allergic rhinitis. All patients were instructed to perform nasal irrigation twice daily for four weeks. The patients were randomly assigned to use either the squeeze bottle nasal irrigation or a syringe for nasal irrigation. Symptoms score, physical examination results, satisfaction scores and adverse events were collected. RESULTS: There were 116 patients enrolled in the study, 58 of whom used the squeeze bottle nasal irrigation system and 58 of whom used a syringe. During a four-week follow-up, improvements in patients' nasal symptom scores for rhinitis symptoms were significantly greater in the group treated with the squeeze bottle. However, the physical examination score was no statistically significant difference. No adverse events were reported. The overall satisfaction scores for both devices were excellent. CONCLUSIONS: This study supports the regular use of nasal irrigation with a positive-pressure device, particularly a squeeze bottle, as an effective adjunctive treatment for allergic rhinitis. It is effective for reducing allergic rhinitis symptoms and can be used by patients with good compliance and minimal side effects.

Clinical presentation and treatment of melioidosis in the head and neck region.

BACKGROUND: Although melioidosis in the head and neck region is uncommon, it is a potentially life-threatening infection. Thus, early diagnosis and proper management are very important. OBJECTIVES: To report the clinical presentation and management of melioidosis in the head and neck. METHOD: A retrospective study was conducted from 1 January 2013 to 31 October 2016 in Mukdahan Hospital, Thailand. Case records of patients who had presented with culture-positive melioidosis were analysed. RESULTS: Medical records of 49 patients (23 males and 26 females) were analysed. Patients ranged in age from 1 to 75 years. Clinical presentations included 22 parotid abscesses, 16 neck abscesses and 11 suppurative lymphadenitis cases. Only 35 patients (71 per cent) had high indirect haemagglutination assay titres of ≥ 1:160 (95 per cent confidence interval = 45.35-88.28). Almost half of the patients received intravenous ceftazidime and subsequently oral co-trimoxazole. Oral antibiotic regimens were prescribed for mild localised melioidosis. Overall, 95.65 per cent of patients were in remission and no relapses were observed (95 per cent confidence interval = 85.47-98.80). CONCLUSION: Careful clinical correlation and proper investigation are required to establish an early diagnosis of melioidosis and to initiate appropriate treatment.

Effects of anatomical variation on trainee performance in a virtual reality temporal bone surgery simulator.

OBJECTIVE: To investigate the importance of anatomical variation in acquiring skills in virtual reality cochlear implant surgery. METHODS: Eleven otolaryngology residents participated in this study. They were randomly allocated to practice cochlear implant surgery on the same specimen or on different specimens for four weeks. They were then tested on two new specimens, one standard and one challenging. Videos of their performance were de-identified and reviewed independently, by two blinded consultant otolaryngologists, using a validated assessment scale. The scores were compared between groups. RESULTS: On the standard specimen, the round window preparation score was 2.7 ± 0.4 for the experimental group and 1.7 ± 0.6 for the control group (p = 0.01). On the challenging specimen, instrument handling and facial nerve preservation scores of the experimental group were 3.0 ± 0.4 and 3.5 ± 0.7 respectively, while the control group received scores of 2.1 ± 0.8 and 2.4 ± 0.9 respectively (p < 0.05). CONCLUSION: Training on temporal bones with differing anatomies is beneficial in the development of expertise.

Technical nuances of commonly used vascularised flaps for skull base reconstruction.

BACKGROUND AND METHODS: Reconstruction with a vascularised flap provides the most reliable outcome, with post-operative cerebrospinal fluid leak rates of less than 5 per cent. This article aims to review and summarise the critical technical aspects of the vascularised flaps most commonly used for skull base reconstruction. RESULTS: Vascularised flaps are classified as intranasal or extranasal. The intranasal group includes the Hadad-Bassagaisteguy nasoseptal flap, the Caicedo reverse nasoseptal flap, the nasoseptal rescue flap, the posteriorly or anteriorly based lateral wall flaps, and the middle turbinate flap. Extranasal flaps include the transfrontal pericranial and transpterygoid temporoparietal flaps. CONCLUSION: The Hadad-Bassagaisteguy nasoseptal flap is overwhelmingly favoured for reconstructing extensive defects of anterior, middle and posterior cranial base. Its pertinent technical features are described. However, it is essential to master the skills required for the various extranasal or regional vascularised flaps because each can offer a reconstructive alternative for specific patients, especially when open approaches are needed and/or intranasal vascularised flaps are not feasible.