Biomedical subjects
Publications and source records attributed to J M Lancer.
A case of facial trauma is presented, which was complicated by a denture fragment lodged in the larynx. This potentially life threatening event caused minor symptoms only. Its diagnosis and management are reported.
In 1963, Brodnitz conducted a study which assessed the vocal recovery incidences for patients with voice problems, which included a group of patients with vocal cord nodules (singers' nodules). Nagata et al., (1983), compared the long-term outcome in vocal nodule patients treated by surgery alone, with those treated by minimal conservative measures, and those not treated at all. However, there is no reported study which compares the long-term outcome of patients with vocal cord nodules treated surgically with those treated with a combination of surgery and speech therapy, and those treated only with speech therapy.
Vocal cord nodules have a variety of synonyms in the literature, including laryngeal nodules, laryngeal nodes, corditis nodosa, singers' nodes, teachers' nodules, screamers' nodes, parsons' nodes, and nodular laryngitis. All of these refer essentially to the same condition. In 1954 referring to vocal cord nodules, Brodnitz and Froeschels wrote that, 'Ever since Tuerck first described the condition in 1868, discussion of the aetiology, the histological nature, and the therapy still has not ceased'. This statement still applies today.
Thirty-two consecutive patients undergoing middle ear surgery using local anaesthesia were assessed on the adequacy of anaesthesia for their surgery, both by the patients themselves, and by the surgeon. A method of local anaesthesia is described which includes the possibility of inducing an iatrogenic transient homolateral facial weakness in order to simplify the technique of administration of anaesthesia. Both the surgeon and the patients were happy with the quality of the anaesthesia, and no adverse effects occurred either as a consequence of the local anaesthesia itself, or of the transient facial weakness.
The operation of submucosal diathermy is commonly performed for the relief of nasal obstruction due to mucosal swelling. In this study the effect of the procedure on nasal resistance to airflow is assessed by rhinomanometry. The results show that although the operation is effective in the short term (two months), there is no significant difference between the nasal resistances prior to surgery and at 15 months after surgery.
A method of rhinomanometry is described for use in clinical research work. The statistical distribution of nasal resistance values is studied in a sample of 59 normal individuals. The variation of nasal resistance within two individuals is studied over a period of 7 hours. The choice of appropriate statistical tests to be used when comparing nasal resistance values is discussed. The reproducibility of nasal resistance measurements is assessed in 47 normal individuals. The results were used to define a normal range of values for total nasal resistance to airflow.
Nasal resistance to airflow was measured by both anterior and posterior rhinomanometry in 15 healthy volunteers. It was found that the posterior method gave values on average 16% higher than the anterior method. This difference was statistically significant. We propose that this is due to posterior rhinomanometry measuring the resistance of the nasopharynx as well as the resistance of the nose. In the past a discrepancy between the 2 methods has been claimed to be due to an error in the standard form of the parallel resistance equation. This hypothesis was tested by measuring total nasal resistance by posterior rhinomanometry and comparing this with a total nasal resistance value derived from posterior rhinomanometric measurements of the resistance of the individual nasal cavities. The standard form of the parallel resistance formula was used to derive the total nasal resistance. There was no significant difference between the 2 values for total nasal resistance. We conclude that if measurements are made at the same pressure gradient then the use of this equation is valid.
The effect of local anaesthesia of the nasal vestibule on nasal sensation of airflow and nasal resistance was assessed in 15 subjects. A single blind parallel group trial was undertaken in 30 subjects, with lignocaine as the active drug, and normal saline as the placebo. Fifteen subjects were included in each group. Both agents were infiltrated bilaterally into the floor of the nasal vestibule on each side via the sublabial route. Local anaesthesia of the nasal vestibule by infiltrating lignocaine produced a sensation of nasal obstruction in 9 out of 15 subjects (P less than 0.02). The infiltration of normal saline had no such effect. The difference between the effect of the 2 agents on nasal airflow sensation was significant (P less than 0.05). Neither injection had any significant effect on nasal resistance to airflow as assessed by active anterior rhinomanometry.
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Documentation of normal and pathological anatomy is important to all medical practitioners. The ability to visualize and photograph the upper respiratory tract has been revolutionized by the advent of the flexible fibreoptic rhinolaryngoscope (FFRL), which demonstrates a one-instrument capability for the examination and photodocumentation of the ears, nasal cavity, nasopharynx, larynx, hypopharynx and trachea (Selkin, 1984). If a large natural maxillary ostium, or surgical window, is present, the antrum may also be examined.
Local anesthetic infiltrated into the external auditory meatus prior to ear surgery is a cause of transient ipsilateral facial nerve paralysis in the immediate post-operative period. This phenomenon is only rarely described. Three such cases are reported.
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The effect of aspirin on nasal resistance to airflow was investigated by rhinomanometry in 25 healthy subjects before and after ingestion of aspirin or vitamin C in a double blind crossover trial. Aspirin caused a significant increase in nasal resistance compared with vitamin C. The effect of aspirin may be due to its inhibition of the synthesis of prostaglandins.
An accurate, reliable, inexpensive and safe method for the examination of the upper aero-digestive tract is described. Its efficacy is evaluated retrospectively on 250 patients over an 18-month period.
Twenty-one patients with nasal obstruction due to allergic or vasomotor rhinitis were assessed rhinomanometrically before and after the operation of submucosal diathermy to the inferior turbinates. It was found that the operation significantly improved the nasal airway. Most patients with an objective improvement reported a corresponding reduction in nasal obstruction. There was no tendency for patients with allergic rhinitis to be dissatisfied with the operation.