Biomedical subjects
Publications and source records attributed to H Zeitoun.
We report a case of aspiration pneumonitis following the use of papain enzyme in a patient with chronic obstructive pulmonary disease with meat impacted in his oesophagus.
OBJECTIVE: To determine the risk of recurrent tumor in patients after incomplete resection of acoustic neuroma. STUDY DESIGN: Retrospective case review. SETTING: A tertiary referral center. PATIENTS: Thirty-nine patients were identified who underwent incomplete resection of acoustic neuroma between January 1988 and December 1993, and had a minimum follow-up of 3.5 years, at a mean of 6.2 years (range 3.5-10.2 years). INTERVENTION: Regular follow-up. using either computed axial tomography or magnetic resonance imaging yearly. MAIN OUTCOME MEASURES: Growth of residual tumor as determined by the increase in its greatest dimension on follow-up imaging studies and the necessity for additional treatment. RESULTS: Tumor regrowth occurred in 17 patients (44%). Ten patients (26%) required additional treatment during the follow-up period. CONCLUSION: This study suggests that incomplete resection of acoustic neuroma is associated with a significant risk of recurrent tumor requiring subsequent intervention.
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Surgeons choice of an ear pack is dictated by availability, previous training and personal preference. There has been no recent prospective study evaluating the use of different types of ear packs. This randomized prospective study compares the use of BIPP impregnated ribbon gauze (Aurum), Pope wicks (Xomed-Teace), silastic sheeting (Dow Corning) and tri-adcortyl ointment (Squibb) as an ear dressing following 'clear' middle ear procedures via a permeatal approach. The results showed that there was no statistically significant difference in post-operative pain and discomfort experienced, neither was there any significant difference regarding the otolaryngologist's assessment of the degree of canal granulation, stenosis or discharge with the above named packs. This study concludes that non-traditional dressings such as tri-adcortyl ointment or simply a thin silastic sheet placed on the drum are no worse than time honoured BIPP. They have, as well, the advantage of being well-tolerated by the patients.
The process of clerking routine pre-operative admissions involves the house officer taking a full medical history and performing a full physical examination. The diagnostic yield is thought to be low, and the educational value to the house officer is also small. This study addresses the question as to whether routine physical examination is always indicated. One hundred and nine children admitted for routine Otolaryngology procedures were prospectively studied to identify the importance of examination in the pre-operative assessment of patients. The results showed that 51 per cent of the children admitted had risk factors. The medical history was sufficient to identify these risk factors in all patients with the exception of one cardiac condition. This study concludes that a suitable alternative to the current process of clerking such as a standardized nurse history could be safely and efficiently undertaken. Eliminating the tiny percentage of previously unrecognized disease would be a prerequisite for such a change.
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The relationship between upper and lower respiratory tract infections has been demonstrated previously, although the effect of chronic infection of one tract on the other has not been well studied. This work analyses the broncho-alveolar lavage fluid of patients with chronic purulent rhino-sinusitis and reveals an increase in total and neutrophil cell counts as well as an increase in immuno-globulin A levels. The associated increase in the neutrophil nitro-blue tetrazolium dye reduction test positivity provides evidence for increased phagocytosis to compensate for the increased contamination of the lower respiratory tract.
The Glasgow benefit plot has encouraged surgeons to look at the results of their surgery from a more functional standpoint rather than in purely technical terms. Our aim was to use the plot to examine the efficacy of second side stapedectomy. A retrospective study of 17 second side stapedectomies showed that the addition of the second operation significantly increased the chances of achieving at least one 'normal' hearing ear and made 'normal' and symmetrical hearing possible.
Packing of the nasal cavity remains a common routine precautionary measure following septal surgery. The nasal pack and its removal 24 h later are often cited by patients as the most painful aspects of septal surgery. We present the results of a randomized, prospective controlled trial of the use of topical 5% lignocaine ointment as a method of pain relief following post-operative nasal packing. Post-operative pain as measured using a visual analogue scale at 3 h post-operatively was halved in patients receiving a lignocaine impregnated nasal pack compared with those having a standard vaseline gauze pack (P < 0.05). Pain scores at 6 h post-operatively and at pack removal were also reduced, but these failed to reach significance. No patients suffered reactionary haemorrhage. The use of topical lignocaine ointment is safe and may have a place in the relief of pain due to post-operative nasal packing.
A direct referral hearing aid clinic (DRHAC) was set up at the Manor Hospital, Walsall, in which patient management was undertaken by an experienced senior medical technical officer in audiology and re-evaluated by an otolaryngologist. After 2 years of offering the service, we audited our experience which is presented in part one of this article. We attempted to assess the referral protocol in part two of the article. During the 2 years, general practitioners referred 458 first-time hearing aid users to the DRHAC. Of these, 91.3% were satisfactorily managed by the audiology department, although only 241 (52.6%) fitted the guidelines developed by the liaison group of the Technicians, Therapists and Scientists in Audiology (TTSA), a lower percentage than expected by the liaison group. All patients who failed to fulfil the TTSA guidelines at the DRHAC were further studied. This revealed that none of the TTSA criteria could be disregarded, but that relying on the experience of the general practitioner and audiologist is an appropriate method for excluding those patients requiring otolaryngological evaluation. It also indicated that the age of 60 years is a suitable limit for patient referrals.
A rare complication of denture use is presented. The clinical and radiological findings are documented and the optimum method of treatment discussed.
Although the short- and long-term results of surgical procedures for treatment of posterior pharyngeal diverticula are well documented, their effect on normal swallowing has not been extensively investigated. The aim of this study was to assess the changes in swallowing that occur after diverticulectomy with cricopharyngeal myotomy. Fifteen patients who underwent surgery in the previous 10 years were interviewed, examined and underwent a video-fluoroscopic barium swallow. Frame to frame analysis of the barium studies showed a multitude of abnormalities, even amongst those who were asymptomatic. Excision of a pharyngeal pouch does not appear to restore a normal swallowing mechanism.
In this study the accuracy of a questionnaire filled in by 109 parents of children admitted for routine ENT surgery was compared with the well recognized verbal clerking. A major problem in communication between doctors and parents was highlighted, as just 44% of the parents were able to state the operation their children were admitted for. The study also showed that it is impossible to rely on parents to give the information required in the form of replies to questionnaires as the sensitivity of the questions designed to recognize risk factors was poor.
Since the introduction of stapedectomy with reconstruction of the ossicular chain to Great Britain, many modifications in practice have taken place. The changes include patient selection, operative technique and the type of prosthesis used, as well as the number of operations performed yearly. The aim of this study is to attempt to establish the actual practice among British otolaryngology consultants by means of a simple questionnaire. Two hundred (50.3%) forms were analysed anonymously. The study confirms the decrease in the number of operations performed annually, the absence of centralization for this type of surgery in Great Britain and also demonstrated the trends towards stapedotomy and the practice of bilateral surgery amongst younger consultants.
This article describes how a nurse-led ear care clinic was developed at the North Staffordshire Hospital NHS Trust to reduce patients' waiting time. A nurse was trained under the supervision of two consultants and one registrar, and an assessment of the service after the first eight months showed that the clinic was successful and popular with patients.