Biomedical subjects
Publications and source records attributed to M W Bridger.
Facial pain of cardiac origin is rare. There are several references in the world literature to angina referred to the teeth and the mandible. This report describes a patient with facial pain which was thought to be of sinus origin and which was relieved by coronary stenting.
INTRODUCTION: Globus sensation is a common condition accounting for about 4% of new referrals to an ENT clinic. A review of current theories on the cause of globus sensation concludes that no single aetiology is responsible. Wareing et al believed that globus sensation might in part be associated with excessive laryngeal and pharyngeal tension. The aim of this study was to substantiate in a controlled prospective manner the results of a non-controlled study by the same authors that certain speech therapy techniques improved globus symptoms. METHODS: 1. 36 patients with typical globus pharyngeus symptoms were randomised to treatment with speech therapy (Study group) and reassurance by nurse practitioner (Control group). The following data was collated for each patient: duration and type of globus symptoms (sense of a lump in the throat/throat irritation), severity of globus symptoms on a visual analogue scale, fibreoptic laryngoscopy, full blood count, barium swallow. 2. At the end of 3 months, patients in both groups marked on the visual analogue scale the severity of their symptoms. RESULTS: There was a significant improvement in the globus symptom scores in the speech therapy group compared to pre-intervention scores (p < 0.001, Wilcoxon rank test). There was also a significant improvement in globus symptoms in the speech therapy group compared to controls (p < 0.001, Mann-Whitney U test). CONCLUSION: Initial results suggest that patients with globus pharyngeus symptoms benefit from speech therapy.
OBJECTIVE: A number of well validated quality of life (QoL) instruments are available. Head and neck cancer patients often find these exhaustive questionnaires too long or bothersome. The purpose of our study was to evaluate a patient self-reported very simple assessment of quality of life and to compare it with the well-validated European Organisation for Research and Treatment of Cancer (EORTC) QoL questionnaire. METHODS: A departmental simple questionnaire was designed consisting of 2 components: 1. A visual analogue scale; 2. A space for patients to enter up to 3 specific problems which prevent quality of life being better. These may be physical, emotional, social or practical problems. 112 patients attending the head and neck oncology clinic completed both questionnaires (half completed the simple questionnaire first and the other half the EORTC questionnaire first). RESULTS: There was a good correlation between the global health scores of the EORTC and the visual analogue scale of the simple questionnaire. There was poor correlation between specific domains in the EORTC questionnaire and the 3 comments mentioned by patients in the simple questionnaire. CONCLUSION: A simple patient assessment of quality of life can be used as a simple outcome tool in head and neck cancer data bases when specific details are not required.
Provision of a nasal field in nasal surgery is hampered by nasal hairs. We recommend the Remington NE4 nasal shaver as a quick, painless, safe, inexpensive method of nasal hair removal, providing a user-friendly surgical field.
We present a previously undescribed event where an inhaled foreign body was propelled into the post-nasal space by the Heimlich manoeuvre. We present figures showing a drop in the mortality following inhaled foreign bodies since the introduction of the Heimlich manoeuvre.
Thyroglossal duct remnants presenting as a lump in the neck are usually called thyroglossal cysts. Meticulous dissection of the cyst and duct, along with the body of the hyoid bone (Sistrunk's operation) is necessary to avoid recurrence. The authors have reviewed the histology of 61 consecutive specimens diagnosed preoperatively as thyroglossal cysts and have found that a true cyst exists in only 46 per cent of cases.
OBJECTIVE: Uvulopalatopharyngoplasty (UPPP) has become a routine operation for snoring. Many centres have published their results. Few, if any, have questioned their patient's subjective feelings regarding the operation and more importantly, the patient's partner. METHOD: The study involved postal questionnaires and a retrospective case note review. Between the years 1988 and 1995, 125 patients underwent a UPPP for snoring at Derriford Hospital, Plymouth, England, a large district general hospital. Postal questionnaires were sent to all patients and their partners, asking them about their experience of snoring and of the operation. The subjective postoperative change in the patient's snoring and their day time sleepiness was measured by the Epworth Sleepiness Score. RESULTS: The number of joint questionnaires returned was 90. The number of patients who felt that their snoring had improved after the operation within the first year was 100%, but this fell to 71% after 1 year. There was a significant improvement in the patient's daytime sleepiness after the operation. The list of complications included pain and nasal regurgitation, along with a dry mouth and altered taste. Overall, 78% of patients would recommend the procedure to others. CONCLUSIONS: The operation of UPPP is successful in reducing the severity of snoring noise in the majority of patients, as well as in improving the quality of the patient's sleep. This success, however, decreases with time and must be put in context with the relatively high morbidity.
A rare case of invasive aspergillosis of the paranasal sinuses in a previously healthy individual is presented. The disease caused severe complications and proved fatal. Classification, aetiology and presentation of sinus aspergillosis are discussed. Early diagnosis and management is stressed to avoid the high incidence of morbidity and mortality.
Forty-one adults were entered into a prospective study to investigate the pattern of pain over 10 days after elective dissection tonsillectomy. The severity of pain was scored by the patient on a visual analogue scale. The results confirm that tonsillectomy is a very painful experience and the provision of adequate analgesia is of paramount importance, especially if day-case tonsillectomy is performed.
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The influence of raised body temperature on the auditory evoked brainstem responses (BSER) has been investigated in 9 healthy volunteers. Ipsi- and contralateral BSER recordings were obtained before and after raising body temperature by at least 1 degree C by means of a specially constructed heat cradle. In two of the subjects further BSER recordings were obtained after their body temperature had been allowed to fall again to its preheated level. The results for wave V have been analysed in detail: the latency in the 5 men shortened from a mean of 5.84 ms (s.d. 0.193) to a mean of 5.62 ms (s.d. 0.185). For the 4 women the figures were 5.87 ms (s.d. 0.105) and 5.68 ms (s.d. 0.105). Using paired t-tests this change is highly significant (P less than 0.001). Similar changes were observed in the other waves although they were less consistent. In the 2 subjects who were allowed to cool again after heating, the BSER wave latencies returned to their preheated values. It is concluded that nerve conduction rates in the auditory pathway are influenced by body temperature and that this may have to be taken into account when interpreting BSER recordings.
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The records of 109 patients, presenting with functional voice disorder during the years 1977-1981, have been reviewed. The mean age was 45 years and the F : M ratio is 2 : 1. Excess voice use was not obviously an aetiological factor. Sixty-one of the 109 patients (56 per cent) were cured by speech therapy, in that their voices returned to their pre-morbid state, and a further 28 (26 per cent) were improved by therapy; seven patients (6 per cent) did not improve and 13 (12 per cent) were lost to follow-up. Of the patients that were 'cured', 54 per cent were discharged after three months' treatment and 72 per cent after six months' treatment. Eight per cent required treatment for more than a year.
The 8th cranial nerve has been dissected from 23 adult temporal bones at autopsy and studied histologically. It was found that neuroglial tissue, continuous with that in the brain stem, supported 8th nerve axons to just beyond the mid-point of the nerve. Lateral to this, axons are supported by Schwann cells and neurilemmal sheaths with a short 'junctional zone' intervening. The point at which the transition occurred, from neuroglial to Schwann cell portions, was medial to the porus in 56 per cent of cases, level with the porus in 18 per cent, and within the internal auditory canal in 26 per cent. The relevance of these findings to some aspects of 8th nerve pathology and surgery is discussed.
The classic sequence of pathologic changes associated with rheumatoid arthritis as they affect the cricothyroid and cricoarytenoid joints of five larynges is described. Although several previous reports have drawn attention to the presence of rheumatoid arthritis in the larnx, the current study emphasizes that the small joints of the larynx may be involved by the full spectrum of pathologic changes and that both cricothyroid and cricoarytenoid joints are equally prone to the various stages of inflammation, joint destruction and ankylosis that characterize the disease elsewhere. Rheumatoid nodules were seen in two cases and granulomatous areas surrounding cricothyroid joints were noted in two others.
The clinical records of 69 patients who had Teflon injection of the vocal cord are reviewed. The indications for treatment, methodology and results of therapy are discussed. The histological findings in three serially sectioned autopsy larynges which had been injected with Teflon paste during life are also presented. Special attention is given to the distribution of Teflon and to the local tissue reaction. The findings are discussed in conjunction with the current concepts regarding the use of this therapeutic modality.
One hundred and fifty-eight cases of paranasal sinus cancer have been reviewed retrospectively. The actuarial survival at five years for the whole group was 33%. The American Joint Committee (AJC) classification for maxillary cancer was used. T1 and T2 cases, with an actuarial survival of 44% at five years, had a significantly better prognosis than T3 cases (31%) and T4 cases (10%). Anemia of presentation and the presence of persistent disease when surgery followed pre-operative irradiation were poor prognostic indicators. The policy of combined pre-operative irradiation followed by surgery is advocated; patients with anemia should have this corrected before and during treatment.
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