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Biomedical subjects

M B Pringle

Publications and source records attributed to M B Pringle.

11 recordsLinked to original sources

Vocal process granulomata.

The case records and histology of 34 patients with vocal process granulomata were reviewed. The five patients presenting most recently with idiopathic vocal process granulomata were investigated by axial computerized tomography (CT). Increased density of the arytenoid cartilage on the side of the lesion was found in all five cases. It is suggested that this indicates cartilage ossification, secondary to perichondritis. This perichondritis, playing either a primary or a secondary role in granuloma development, may explain the annoying tendency of vocal fold granulomata to recur after excision.

Adult

Use of the trimmed Shah permavent tube in the management of glue ear.

Twenty-five children (mean age six years) with de novo bilateral ear effusions received a 'trimmed' high grade silicone (HGS) Shah permavent ventilation tube in one ear and a conventional polyethylene Shah grommet in the other. The extrusion rate and the degree of tympanosclerosis formation was examined. At 29 months the conventional grommet had extruded in 90 per cent of children and a recurrent middle ear effusion was found in over 50 per cent of these ears. The average length of stay for the conventional grommet was 12.5 months. Five permavent tubes had extruded, one was extruding but the remainder were all in place and patent. Comparing ears on each side the amount of tympanosclerosis was worse in the ear with the conventional grommet in 47 per cent of children and worse on the permanent side in 11 per cent of the children. The 'trimmed permavent' appears to act as a medium to long-term grommet which self extrudes without serious complications. Its use at the primary operation in young children may save repeated insertions of conventional grommets.

Child

The use of digital subtraction angiography in penetrating neck injury--a very instructive case.

This case report illustrates the value of intravenous digital subtraction angiography (DSA) in cases of penetrating neck injury. The debate continues between a policy of mandatory exploration of all penetrating neck wounds versus one of selective exploration with observation of the remainder. The argument for the former policy is that vascular trauma can occur without clinical signs. Whichever policy is followed a DSA provides invaluable information in strengthening the decision either not to operate or if operating which operation to perform and which approach to use. DSA is a quick, simple and safe investigation that can be carried out at any time of day or night.

Adult

Grommets, swimming and otorrhoea--a review.

Ever since Armstrong reintroduced the concept of grommet insertion parents have been asking 'may my child swim?', yet there is still no consensus as to the correct answer. This paper reviews the work that has been done on this subject in the last 25 years. A review of the rates of otorrhoea following grommet insertion, irrespective of swimming, shows a variation from 12 to 64 per cent. Evidence suggests that pressures of 12-23 cm H2O are needed to push water through a grommet and that it is unlikely that water will enter the middle ear during surface swimming. Only bath water seems to cause significant inflammatory changes to middle ear mucosa. Not a single paper comparing swimmers with non-swimmers shows an increased rate of otorrhoea in those patients who swam; to the contrary, rates of otorrhoea were repeatedly higher in those patients who did not swim. The evidence suggests that swimming without ear protection can be safely permitted for children with grommets.

Adolescent

A comparison of speech audiometry and pure tone audiometry in patients with secretory otitis media.

Speech audiometry was performed on 15 children with secretory otitis media pre- and post-operatively and the findings compared with the pre- and post-operative pure tone audiograms. The results showed that in 30 per cent of cases pre-operatively the speech audiogram suggested a significantly worse hearing ability than that suggested by the pure tone audiogram (PTA). Where a PTA gives a borderline threshold disproportionate parental concern should be taken seriously as the hearing ability may well be worse than the PTA suggests.

Audiometry, Pure-Tone

Sensorineural hearing loss caused by metastatic prostatic carcinoma: a case report.

Metastases to the temporal bone are a recognized, if rare, cause of otological symptoms including sudden sensorineural hearing loss. Carcinoma of the prostate is a common cancer which frequently metastasizes to bone but is only rarely reported in the temporal bone. We report a case of sudden sensorineural hearing loss due to metastatic prostatic carcinoma in the temporal bone.

Evoked Potentials, Auditory, Brain Stem

The use of intra-nasal splints: a consultant survey.

A questionnaire was sent to all United Kingdom consultants enquiring about their use of intra-nasal splints. 301 (70%) consultants replied. The commonest reason given for use of nasal splints was to try to prevent the formation of adhesions. Flat, pre-shaped silicone rubber splints were by far the most frequently used type. 64% used splints routinely for operations involving both walls of the nasal cavity. Just over one-third of respondents never or 'rarely' (less than 1 in 50 cases) used splints for procedures involving both walls of the nasal cavity. They reported an adhesion rate of 5.2% which was only 1.3% greater than that reported by those who always or 'sometimes' (at least 1 in 10 cases) used splints. Comments from some respondents and review of the literature suggests that early out-patient review with the use of nasal toilet is an effective alternative to using nasal splints in the prevention of intranasal adhesions.

Consultants

Prevention of occupational transmission of HIV in the ENT clinic.

Much attention has been focused on the risks of inoculation with the human immune deficiency virus in the operating theatre. However, less emphasis has been placed on infection resulting from outpatient exposure to this pathogen. A survey of current protective measures undertaken by ENT consultants in the outpatient clinic in the United Kingdom is presented. The precautions employed by the majority of these subjects are inadequate and non-universal. A review of the risk factors and subsequent safety recommendations is detailed.

Eye Protective Devices

A comparison of sleep nasendoscopy and the Muller manoeuvre.

Knowledge of the level of pharyngeal obstruction during sleep is an important factor in deciding whether or not a patient suffering from obstructive sleep apnoea syndrome (OSAS) will benefit from uvulopalatopharyngoplasty. The Muller manoeuvre has been advocated as a method of obtaining this information. We compared the findings from the technique of sleep nasendoscopy, which actually allows visualization of the level of obstruction in the sleeping patient, with the results of the Muller manoeuvre performed in the same patients while awake. We found the Muller manoeuvre to be less accurate than previously believed.

Airway Obstruction