Aural microsuction: an analysis of post-procedure patient safety incidents.

BACKGROUND: Aural microsuction can be associated with delayed syncopal and vertiginous events, which can lead to serious adverse patient safety incidents. OBJECTIVE: This article highlights the serious risks associated with microsuction. MATERIALS AND METHODS: We performed a retrospective review of the hospital risk database over a 2-year period. RESULTS: Three patients experienced severe adverse events post microsuction. Two patients fell down the stairs after microsuction, with one suffering a lower limb fracture. One patient experienced loss of consciousness and subsequent head trauma post microsuction. CONCLUSIONS AND SIGNIFICANCE: Whilst aural microsuction is universally accepted to be a low-risk procedure, subsequent serious morbidity can occur. Implementation and awareness of local safety policies are imperative to avoid post-procedure injury.

Endoscopic treatment of sinonasal papilloma: a 12 year review.

CONCLUSION: Endoscopic surgical management is recommended as a viable treatment option for sinonasal papilloma, with comparable results to those treated by an external approach. An external approach is still indicated in cases where the papilloma is not accessible endoscopically, or where there is extrasinus invasion. Long-term follow-up is essential for recurrence detection. OBJECTIVES: The goal of this study was to highlight our experience with endoscopic surgery for the management of sinonasal papilloma. PATIENTS AND METHODS: A retrospective study of all patients who underwent endoscopic surgery for the treatment of sinonasal papilloma over a 12 year period at the Gui de Chauliac Hospital, Montpellier, France. RESULTS: A total of 55 patients were included in this study; 32 patients (58%) were treated exclusively by an endoscopic approach and 23 (42%) were treated by a combined approach. Minimal follow-up was 3 years. The overall recurrence rate was 7%. All recurrences occurred at the initial site and the average delay between surgery and recurrence was 30 months (14 months to 4 years).

Solitary parathyroid adenoma: a rare cause of primary hyperparathyroidism in children.

Solitary parathyroid adenoma is a rare cause of primary hyperparathyroidism in children. We report the cases of four children, aged 7 to 14 years old, who presented with a variety of symptoms (growth retardation, glomerulonephritis, pathological fracture, mood swings). Diagnosis was based on clinical examination, imaging, and biochemical analysis. Treatment consisted of surgical excision of the adenoma. As diagnosis was delayed in all four patients, we recommend systematically checking serum calcium levels in children with certain nonspecific symptoms. Adenoma resection usually restores normal serum calcium levels and, hence, avoids further complications.

Atypical clinical presentations of vestibular schwannomas.

UNLABELLED: A significant number of patients with vestibular schwannomas present atypically, with none of the classical symptoms of unilateral sensorineural hearing loss, tinnitus, and/or dysequilibrium. The aim of this study is to highlight those patients with unusual clinical symptoms. STUDY DESIGN: The clinical data of all patients who presented to the vestibular schwannoma clinic at Beaumont Hospital over the past 12 years was prospectively recorded in a computerized database. This paper reviews the atypical presenting symptoms. RESULTS: Three hundred ninety-eight patients were included in this study. A total of 3.7% of patients presented with atypical symptoms only. CONCLUSION: A significant subgroup, 3.7% in our study, did not present with the audiovestibular symptoms classically associated with vestibular schwannoma. Clinician awareness of the atypical clinical symptoms may lead to earlier detection of these lesions.

Upper airway obstruction in infectious mononucleosis.

Patients with infectious mononucleosis caused by the Epstein-Barr virus frequently present to the accident and emergency department. The most common presenting symptoms are fever, fatigue, odynophagia and malaise. Although significant airway compromise is rare and occurs in an estimated 1-3.5% of cases, it may present as a potentially life-threatening situation demanding immediate intervention. We present two such cases and discuss their management.

Sclerosing polycystic sialadenopathy: a rare cause of recurrent tumor of the parotid gland.

We present a case report of a woman with a recurrent parotid mass that was histologically confirmed to be sclerosing polycystic sialadenopathy, a rarely reported cause of salivary gland tumor. This tumor measured 11.8 x 6 cm, the largest such lesion yet reported. Histologic analysis revealed foci of atypical intraductal acinic cell proliferation and necrosis severe enough to amount to intraductal carcinoma in situ. Despite its large size, it was successfully excised, leaving the patient with only moderate facial nerve dysfunction postoperatively.

Pleomorphic adenoma of the nasal septum.

Pleomorphic adenoma may occur in any site in which there is salivary gland tissue. It has rarely been described arising in the nasal cavity. We report a case of septal pleomorphic adenoma and discuss the clinical presentation and surgical management.

Atypical locations of retropharyngeal abscess: beware of the normal lateral soft tissue neck X-ray.

Retropharyngeal abscesses (RPA) are uncommon but potentially lethal deep neck space infections, over 95% of which occur in children under six years of age. Without a high index of suspicion, early recognition and prompt intervention, catastrophic consequences can ensue, and mortality can be as high as 60% if jugular vein thrombosis or mediastinitis occurs. While older children may have specific complaints referable to the pharynx, infants and young children may present with vague symptoms. To date, a lot of emphasis continues to be placed on the importance of lateral soft tissue neck X-ray in the diagnosis and management of patients with suspected retropharyngeal abscesses; and lateral neck X-ray has been cited as the most useful radiological view of the laryngopharynx. While we recognise the role of lateral neck X-rays in retropharyngeal and other upper airway pathologies, we present three case series in which lateral neck X-rays were normal and diagnosis was made only after CT scanning. These three cases were unusual as the abscesses were located high in the naso-pharynx making them impossible to detect on the lateral soft tissue neck X-rays and this underscores the need for high index of suspicion and prompt CT or MRI scanning, in any child with symptoms or signs suggestive of a possible retropharyngeal abscess.