Biomedical subjects
Publications and source records attributed to W V Carlin.
The authors describe a novel use of a de-epithelialized deltopectoral flap for the closure of tracheo-oesophageal fistulae, which have been resistant to other methods of closure.
The routine use of topical anaesthesia during flexible nasendoscopy has been questioned, and the degree to which topical vasoconstrictors can affect patient discomfort has yet to be elucidated. Patients' experiences with Lignocaineand phenylephrine, Lignocaine alone, xylometazoline and no preparation were compared. One hundred patients were recruited in this double-blind, randomised control trial and put into these four groups. Each patient completed a visual analogue scoring chart to determine the severity of unpleasantness and other undesirable effects (pain, bad taste, burning, choking, numbness and difficulty in swallowing). The results confirmed that vasoconstriction is a major contributing factor towards reducing overall unpleasantness (P = 0.022), topical anaesthesia can produce a bad taste (P = 0.022), and that none of the preparations have any effect on the pain during nasendoscopy. In conclusion, xylometazoline is recommended for nasendoscopy as it is effective and is significantly cheaper than the other preparations. Not using any preparations leads to the experience of severe symptoms.
The aim of this prospective study was to determine the suitability of 'direct listing' of patients for tonsillectomy by their General Practitioner. All General Practitioners were issued guidelines outlining the indications and contraindications for direct listing. One hundred consecutive patients, referred over a 6-month period, were screened by an otolaryngologist. Thirty-three of these patients were referred inappropriately. The high rate of inappropriate referrals would suggest that this is an unacceptable practice.
Benign necrotizing osteitis of the external auditory meatus is a rare condition which occurs in non-diabetic healthy people. The aetiology of the necrotic process with the formation of sequestrum in the bony external meatus is unknown. It is important to differentiate this benign process from malignant otitis externa and radionecrosis of the temporal bone as the management of these conditions differs. We present two cases, one managed surgically and the other medically, and review the literature. Immediate surgical excision of the sequestrum is advocated instead of long-term medical therapy and waiting for it to separate spontaneously.
The association of sensorineural hearing loss and ulcerative colitis is well documented and it is speculated that this is autoimmune in origin. A case in a 12-year-old boy is described, that initially responded to steroid therapy, but four years later resulted in bilateral, profound sensorineural hearing loss in spite of good control of his bowel disease. Immunological tests may provide a clue as to the aetiology of suspected cases of autoimmune inner ear disease. Immediate treatment with steroids with or without immunosuppressive therapy is essential as delay may lead to irreversible hearing loss.
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.
This study was designed to investigate whether patients with a conductive hearing impairment derive more benefit from the provision of a hearing aid than comparable individuals with a sensorineural hearing impairment. A secondary aim was to assess the relative hearing disability of those with each type of impairment. Twenty-eight patients with a bilateral, symmetrical conductive impairment were selected. They were matched for age, sex and speech frequency average to individuals with a bilateral, symmetrical sensorineural hearing impairment. Each patient performed free-field audio and audio-visual tests in noise, both with and without a hearing aid, during which the non-test ear was acoustically occluded. When unaided, individuals with a conductive impairment were more disabled than those with a sensorineural impairment. On the other hand, those with a conductive impairment derived more benefit from an aid than those with a sensorineural impairment.
Twenty-eight patients with nasal obstruction due to vasomotor rhinitis were assessed using anterior rhinomanometry before and six weeks after the operation of out-fracture and amputation of the posterior ends of the inferior turbinates. It was found that the operation did not significantly improve the nasal airway. Though just over half the patients had an objective improvement in nasal airflow, only half of this group reported a subjective improvement in their symptoms.
This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery. A total of 130 individuals were randomly allocated to either an antibiotic or a non-antibiotic group. Each individual was clinically and audiometrically assessed preoperatively, and 8 weeks postoperatively. It was found that systemic prophylactic antibiotics did not influence either the success rate of myringoplasty surgery or the audiometric result.
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This paper reports a multicentre, controlled, blind, prospective, randomized study into the use of prophylactic systemic antibiotics in myringoplasty surgery. Seventy-one individuals were clinically and bacteriologically assessed both preoperatively, and for a period of 8 weeks postoperatively. The results showed that antibiotic prophylaxis did not eradicate bacterial pathogens already present in preoperative ears, nor did it prevent their development during the postoperative period. The observation that an ear was wet or dry gave no indication of the actual presence or absence of pathogenic organisms.
A 64-year-old man underwent laryngectomy, partial pharyngectomy and right block dissection of the neck for a squamous cell carcinoma of the right pyriform fossa with an involved right neck node. He had received pre-operative radiotherapy. The operation was uneventful. A 'Drevac' wound drainage system (Astra Meditec) was inserted in each side of the neck.
To date there is no ideal method of painlessly achieving anaesthesia of the ear drum for myringotomy and grommet insertion. In this double blind, placebo controlled prospective study we have assessed a new topical anaesthetic agent (EMLA Cream) for use on keratinised squamous epithelium. A comparison has been made with the anaesthesia achieved by an injected agent. Twenty individuals were randomly allocated to receive placebo or EMLA cream. Their relative discomfort was measured on a visual analogue scale. Ten individuals received injected anaesthetic prior to myringotomy and grommet insertion and the discomfort of injection and of the procedure were similarly measured. We found EMLA cream to be an equally effective method of anaesthetising the ear drum as an injected agent. In addition there was minimal discomfort in the achievement of this anaesthesia. The discomfort of injecting the ear canal is shown to be similar to that of performing myringotomy and grommet insertion without anaesthesia.