An improved instrument mounting arm.

Although some form of commercial instrument mounting arm is available, a paucity of information in the literature may cause problems in selecting the most appropriate model for an ENT department wishing to trial their invention for use in the clinic or operating theatre. The instrument mounting arm described here is based on existing designs used by hobbyists and model makers for many years but the main benefit of this innovation is its multi-purpose use in the operating theatre and cost effectiveness since it is made of aluminum alloy. It is compact, stable and easily adjustable and can incorporate an endoscope holder or an operating end piece to mount various ENT instruments that offers considerable advantages to the unassisted operator.

Successful treatment of juvenile laryngeal papillomatosis-related multicystic lung disease with cidofovir: case report and review of the literature.

Cidofovir, a nucleoside analog antiviral agent, has been used with moderate success in the treatment of juvenile laryngeal papillomatosis (JLP) by direct intralesional injection. We report the first case where IV cidofovir was used successfully to treat a rare but lethal multicystic lung disease complicating JLP. A 35-year-old woman with a history of JLP requiring multiple laser ablations of laryngeal papillomata each year presented with hemoptysis and was found on CT scan to have bilateral, multiple pulmonary nodules and cysts. The results of BAL fluid analysis demonstrated no evidence of malignancy, and cultures were negative for fungi and mycobacteria. Molecular DNA typing of a biopsy specimen obtained from a laryngeal papilloma confirmed infection with human papilloma virus type 11. She received 12 months of treatment with IV cidofovir followed by 9 months of combined treatmentwith IV cidofovir and subcutaneous interferon-alpha-2A. This therapeutic regime resulted in a markedly decreased requirement for surgical removal of laryngeal papillomata, and CT scanning documented the regression of the lesions in the lung parenchyma that persisted after the discontinuation of therapy. The results of this case demonstrate that cidofovir may be used successfully to treat JLP-related lung disease and suggest that further studies are warranted.

Pediatric ear, nose and throat services' demands and resources: a global perspective.

Global population trends, health care economics and disease patterns are reviewed. The world's population has doubled twice in the twentieth century, and will grow by at least a further 2 billion before stabilizing in the middle of the next century. There is gross maldistribution of wealth and health care expenditures: 20% of the population control 80% of the gross domestic product, the same 20% of the population spend 87% of the total global health care funds. Extreme poverty facilitates all manner of diseases. Globally, infections remain the most important causes of disease. Of these, upper respiratory infections are an important cause of hearing loss and learning handicap in children world-wide. Epidemic meningitis in Africa and parts of Asia is a preventable major cause of death and deafness. There are about 80,000 otolaryngologists in the world and they too are maldistributed, with most in Europe and the Americas. This is exacerbated when looked at from the standpoint of children, most children live where there are fewest otolaryngologists: the differences are greater than two orders of magnitude. This greatly affects the role and scope of paediatric otolaryngology. The discipline is small and rapidly evolving. Suggestions are made for sharing training.

Accessibility for the hearing impaired.

The social anthropology of mild hearing loss is gradually being accepted, as it affects both children and adults. With this comes the understanding that effective aural communication requires adequate sound sources and a good transmission medium as well as good hearing. If the first two conditions are met, much hearing disability might be avoided without resorting to a hearing aid. A plea is made for better accessibility for the hearing impaired by improving environmental conditions for acoustic signals, especially speech.

Desferrioxamine ototoxicity in an adult transfusion-dependent population.

OBJECTIVE: The purpose of this study was to identify the incidence of hearing loss in a population of 75 adult (19-68 years old) transfusion-dependent patients with thalassemia major, sickle cell disease, Diamond-Blackfan anemia, and various other hematologic disorders treated with regular transfusion schedules. Ninety-three percent (70/75) of patients had a history of long-term subcutaneous or intravenous desferrioxamine therapy. METHODS: The patients underwent routine otolaryngologic history and physical examination, along with standard pure-tone audiometry at 250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz, with hearing loss defined as 25 dB or greater at one or more frequencies. RESULTS: Hearing loss was present in 57% (43/75) of patients. More importantly, hearing loss attributable to desferrioxamine ototoxicity was present in 29% (22/75) of patients. Sixteen patients treated previously with desferrioxamine were switched to the experimental oral chelating agent, L1. Eight of these 16 patients had hearing loss attributable to desferrioxamine, with 5 of these patients worsening with the experimental oral chelating agent L1. Seventy-nine percent (59/75) of patients were thalassemic. Fifty-four percent (33/59) of these thalassemic patients had hearing loss. However, 35% (21/59) of the thalassemic patients had hearing loss attributable to desferrioxamine ototoxicity. All thalassemic patients with desferrioxamine ototoxicity had high-frequency sensorineural hearing loss, with 33% (7/21) having a notch at 6 kHz. In addition, 5% (1/21) had notching at 3 khz. Few of the hearing losses were disabling. CONCLUSIONS: Management of these patients requires proper dosing of desferrioxamine and transfusion therapy, along with regular monitoring of body iron burden and hemoglobin. In addition, regular otolaryngologic and audiometric follow-up with special care to include the frequencies of 3 and 6 kHz may help recognize and prevent permanent ototoxicity.

The prevention of hearing loss worldwide.

The prevalence of disabling hearing loss ( >40dB, average 0.5 - 4 KHz) is at least 120 million worldwide. It is estimated that half of this loss is preventable by primary means. These include genetic counselling, stricter supervision of ototoxic drug use, vaccination against common viral diseases, measles, mumps and in selected populations, rubella; vaccination against meningitis, better management of acute respiratory infections, noise control and the appropriate use of hearing protection. Education of individuals, communities and governments is an essential prerequisite to implementation.

Health care economics: impact on hearing loss prevention in the developing world.

Health care resources are unevenly distributed: 15% of the world's population utilise 87%. Physician numbers vary dramatically from one region to another, as does disease distribution and the age of the population. All this impacts both what can be delivered and what is appropriate to a region. Primary prevention is usually effective and much cheaper than treatment or rehabilitation. Alternative health care models are discussed.

Experimental, clinical and preventive aspects of ototoxicity.

Ototoxicity is an important clinical problem and accounts for a significant proportion of sensorineural hearing loss in some parts of the world. Ototoxicity is predominantly an iatrogenic condition. However, with proper dosing, prudent monitoring of serum levels of ototoxic medications and serial audiometry, ototoxicity can be prevented. A number of the more common ototoxic medications, including aminoglycosides, erythromycin, loop diuretics, salicylates, cisplatin, deferoxamine and ototopical agents, are outlined in this review. Their pharmacology, mechanisms of action and methods of preventing complications are discussed together with animal and clinical studies.