Cartilaginous Eustachian tube length and carotid canal dehiscence in children: a radiological study.

PURPOSE: The use of Balloon Eustachian tuboplasty (BET) for Eustachian tube dysfunction is increasing in adults but to a lesser extent in children. Despite growing experience, concerns remain that BET could theoretically cause carotid artery rupture, which may be more likely if there is carotid canal dehiscence adjacent to the bony Eustachian tube. This radiological study aims to assess the prevalence of carotid canal dehiscence and length of cartilaginous Eustachian tube in children. MATERIALS AND METHODS: 75 consecutive computed tomography scans of the petrous temporal bones performed in children were identified (150 carotid canals/Eustachian tubes). Two independent raters measured the length of the cartilaginous Eustachian tube and thickness of carotid canal wall. RESULTS: 8% of carotid canals had radiological dehiscence. Prevalence of carotid canal dehiscence on either side per child was 12%. Mean cartilaginous Eustachian tube length was 24.5 mm (SD 3.1 mm) and the minimum measured was 14.1 mm. The minimum length measured in a child over 3 years old (n = 65) was 18.1 mm. The mean thickness of bone of the carotid canal was 0.7 mm (SD 0.27 mm). There was a positive relationship between age and Eustachian tube length (Pearson's correlation coefficient = 0.622, p < 0.001). CONCLUSIONS: Carotid canal dehiscence in children has a low prevalence. Variation in the length of the cartilaginous Eustachian tube is low but is correlated with age. More research is required to define the indications, safety, efficacy and technical aspects of BET in children.

Clopidogrel versus low-dose aspirin as risk factors for epistaxis.

OBJECTIVES: To quantify the relative risk of epistaxis for patients taking low-dose aspirin or clopidogrel compared to patients taking neither drug. DESIGN: Case-control study. SETTING: Primary care. PARTICIPANTS: 10,241 patients from three GP practices in the West Midlands. MAIN OUTCOME MEASURES: Epistaxis resulting in presentation to the GP, attendance at Accident & Emergency, or referral to ENT outpatients. RESULTS: There was a significant difference in the proportion of patients with epistaxis across the three groups (chi(2) = 84.1; 2 degrees of freedom; P < 0.000001). Relative risk of epistaxis was increased in both the aspirin (RR = 9.04; 95% CI = 5.13-15.96) and clopidogrel (RR = 6.40; 95% CI = 2.33-17.56) groups compared to the no drug group. There was no increased risk of epistaxis with aspirin compared to clopidogrel (RR = 1.4; 95% CI = 0.6-3.4). CONCLUSION: There is an increased risk of troublesome epistaxis in patients taking aspirin or clopidogrel. There is no significant difference in risk of epistaxis between the two drug groups.

Superior petrosal sinus causing superior canal dehiscence syndrome.

OBJECTIVE: To determine signs and symptoms for superior canal dehiscence syndrome caused by the superior petrosal sinus. METHODS: A review of the English-language literature on PubMed and Embase databases was conducted, in addition to a multi-centre case series report. RESULTS: The most common symptoms of 17 patients with superior petrosal sinus related superior canal dehiscence syndrome were: hearing loss (53 per cent), aural fullness (47 per cent), pulsatile tinnitus (41 per cent) and pressure-induced vertigo (41 per cent). The diagnosis was made by demonstration of the characteristic bony groove of the superior petrosal sinus and the 'cookie bite' out of the superior semicircular canal on computed tomography imaging. CONCLUSION: Pulsatile tinnitus, hearing loss, aural fullness and pressure-induced vertigo are the most common symptoms in superior petrosal sinus related superior canal dehiscence syndrome. Compared to superior canal dehiscence syndrome caused by the more common apical location of the dehiscence, pulsatile tinnitus and exercise-induced vertigo are more frequent, while sound-induced vertigo and autophony are less frequent. There is, however, considerable overlap between the two subtypes. The distinction cannot as yet be made on clinical signs and symptoms alone, and requires careful analysis of computed tomography imaging.

The place of rhinoplasty in the ageing face.

Age-related changes in the skin and underlying tissues of the nose may lead to nasal obstruction or an unsatisfactory cosmetic appearance. As the UK population ages, the number of older patients seeking advice from an otolaryngologist about these problems is increasing, and many of these patients may benefit from a rhinoplasty. Quite apart from the practical considerations of operating on more delicate ageing tissues, there are a number of psychological, motivational and social issues specific to rhinoplasty in the older patient. This review discusses these issues, and aims to define the place of rhinoplasty in the ageing face.

Traumatic facial nerve neuroma following mastoid surgery: a case report and literature review.

Traumatic facial nerve neuroma is rare. There are only 10 reported cases in the literature, caused either by physical trauma or chronic inflammation. Traumatic facial neuromata differ from true facial nerve neoplasms in radiological, macroscopic and microscopic appearance, but clinical presentation is less reliable in differentiating the two. Management depends on the pre-operative grade of facial palsy, as this is a benign condition and surgical management carries a risk of further affecting facial nerve function. We present a further case of traumatic facial nerve neuroma following surgery for cholesteatoma. We also review the literature and discuss the management of this condition.