Biomedical subjects
Publications and source records attributed to L M Flood.
Neurological complications following turbinate surgery are relatively rare. We present here an unusual complication of unilateral partial oculomotor and trigeminal nerve palsy after bilateral inferior turbinectomies. The probable aetiological mechanism is discussed.
Fifty children with otitis media with effusion undergoing grommet insertion had into one ear a Mini-titanium grommet inserted and into the other ear a Mini-teflon grommet. Post-operative follow-up until after extrusion of the grommets demonstrated only a small difference between the extrusion times of the two grommets (a significant difference of 41 days) and no difference in the degree of tympanosclerosis seen with each grommet. We propose that the mass of a grommet appears to play less of a role than has previously been suggested in the pathogenesis of tympanosclerosis following grommet insertion and that duration of intubation may be the most significant factor.
Maxillary sinus shrinkage can occur secondary to acquired benign osteomeatal disease. This may be associated with an external deformity and sinus wall sclerosis.
One hundred and sixteen children with otitis media with effusion (OME) underwent surgery with grommet insertion. A conventional Shah grommet was used in one ear, and a Mini-Shah grommet in the other. Final review of the subjects two years after surgery revealed a significantly lesser degree of tympanosclerosis in the ear into which the Mini-Shah grommet had been inserted. This benefit might have resulted from the lesser mass of the mini-tube or its shorter duration in situ.
Three cases of retropharyngeal haematoma are described. In one case there was underlying aneurysm of the carotid artery which could have led to significant morbidity if undetected.
We present an unusual case of iatrogenic arteriovenous malformation following a myringoplasty and its treatment by embolization. Thorough examination and investigation of patients with pulsatile tinnitus is stressed. Angiography is essential to diagnose life-threatening and treatable lesions in the presence of normal otoscopy, audiologic assessment and enhanced computed tomography.
A four-year study was undertaken to determine the value of electron microscopy in the diagnosis of head and neck tumours. During this period 80 samples were submitted for examination, of which 69 contained assessable tumour. Electron microscopy made a major contribution to the diagnosis in 25 cases (36 per cent). Areas in which ultrastructural examination was of diagnostic significance included the precise categorization of apparently undifferentiated carcinoma and the identification of melanomas. Little diagnostic benefit was gained from electron microscopic examination of thyroid, lymphoid or salivary gland neoplasms. The value of electron microscopy in relation to immunohistochemistry is discussed.
An unusual case of a chordoma of the parapharyngeal space is presented with no direct involvement of the axial skeleton. Diagnosis was confirmed with the aid of immunocytochemical tests.
The ENT specialist's experience of emergencies is usually influenced by a process of prior selection in the GP surgery or in a general Casualty Department. A survey of 1,000 consecutive patients presenting to a 24 hour open access ENT Casualty service is presented. For a variety of reasons, over half of these patients had never sought their G.P.'s advice for their ENT complaint but preferred the hospital service. The value of even a brief exposure to ENT casualty work for GP trainees is demonstrated.
A substantial proportion of patients summoned for routine ENT operations simply fail to turn up on the day of admission. Lacking any notice, the hospital has little prospect of finding replacements, with a consequent waste of resources. A one-year prospective study has tried to identify the potential defaulters and sought their own reasons for non-attendance. All patients (n = 181) failing to respond to invitations for admission for surgery were investigated by means of a questionnaire. Non-attenders were matched with those attenders that were listed next on the admission list. The incidence of non-attenders was significantly higher in the group aged 16 years or below. Non-attenders were more likely to be male, on a longer waiting list (P less than 0.05) and listed for nasal septal operations. One in five who failed to attend had changed their address while on the waiting list. The duration of notification appeared not to influence the rate of non-attendance.
One hundred and sixteen children with otitis media with effusion underwent myringotomy and insertion of a conventional pattern of Shah grommet in one ear and the much smaller Mini Shah grommet in the other. Close observation post-operatively determined the comparative rate of extrusion, recurrence of effusion, and of onset and degree of tympanosclerosis. At one year review, the Mini Shah shows a significantly earlier extrusion and a greater tendency to recurrence of otitis media with effusion. However, this is compensated by a decreased incidence of tympanosclerosis and reduced severity in those affected. This tends to support the view that shear forces produced by heavier patterns of ventilation tube promote tympanosclerosis.
ENT Departments in the United Kingdom are faced with increasing pressure from government, management and the Colleges responsible for surgical training to introduce formal medical self audit. The plethora of guidelines and publications on the subject rarely address the differences in clinical practice between general medicine or surgery and that of otolaryngology. Clearly the lead in the introduction of medical audit will come from the appropriate specialist associations; however, this paper aims to share the experience of the implementation of audit in one otolaryngology, head and neck surgery unit and offer suggestions for a programme elsewhere.
This paper reviews a 20 year experience of radiation treatment of 286 laryngeal cancers and presents results with a minimum five year follow-up. All cases presented had glottic or supraglottic squamous cell carcinomas with no clinical evidence of nodal metastasis. A policy of primary radiotherapy with surgery for salvage of treatment failures, produced control of primary disease and prevention of metastases superior to most other regimes documented in the literature.
Cryosurgery of the labyrinth, as a treatment of endolymphatic hydrops, was initially greeted with considerable enthusiasm, but has lately received little publicity. That it still has a valuable role is demonstrated by this study of 69 patients who underwent labyrinthine cryosurgery over a 16 year period. Complete relief from vertigo has been achieved in 71 per cent of cases and morbidity has been minimized by the precautions outlined. The literature is reviewed to demonstrate the superiority of the transmastoid approach, the evolution of the technique and experimental evidence for the supposed mode of action.
A study was undertaken to detect undiagnosed deafness in elderly people, living in Part III Residential Homes in North Tees, South Tees and Hartlepool Health Districts, to provide hearing aids and to estimate the subsequent success in rehabilitation. The residents were referred by the senior staff in the homes and assessed by a doctor and audiology technician in a domiciliary setting. Those found to have a significant hearing impairment were prescribed hearing aids without formal pure tone audiometry. A pilot study compared the method of hearing evaluation employed with such conventional testing. Six months after fitting, the degree of compliance with aiding was assessed. The results show a significant level of undiagnosed deafness in the community and, with this method of provision, an acceptance rate of 41.2 per cent of those recommended for aiding at six months which is higher than suggested by previous similar studies of this population.
Between 1978 and 1981, 85 patients with advanced squamous cell carcinoma of the head and neck were randomized to receive induction VBM followed by radiotherapy, or radiotherapy alone. The shortest follow-up is thus 6 years. The median survival of patients receiving induction chemotherapy was 46 weeks, that of the radiotherapy group alone was 75 weeks. As the two groups were not balanced despite randomization, multivariate methods (GLIM) were used to identify significant prognostic factors. These were: response to radiotherapy (P less than 0.001), nodal status (P less than 0.001), age (P less than 0.01), and histological grade (P less than 0.01). Neither treatment with, nor response to, chemotherapy had a significant effect on survival.
A review of 15 patients, who underwent 34 CO2 laser bronchoscopic procedures, over a 2-year period, is presented. All had malignancies of the tracheobronchial tree and underwent laser surgery to palliate breathlessness or haemoptysis. Partially obstructing and more proximal tumours proved more easily manageable. One quarter of the patients required repeat procedures and there were two deaths in the early post-operative period. The indications for such surgery, the technique and its limitations, and the palliation obtained are discussed.
Sporadic case reports and the few published series of expanding lesions of the deep petrous temporal bone propose a variety of surgical approaches to ensure excision. All such surgery represents a compromise between exposure adequate for total removal and avoidance of further neurological deficit. Unfortunately pathology in the petrous apex evolves relatively silently and diagnosis is delayed. In many cases total excision is impossible. We present a series of patients presenting with advanced tumours of the deep petrous temporal bone in order to illustrate the spectrum of disease encountered, the limited role of surgery and the natural history of irresectable pathology in this remote and inaccessible area.