Validation of sleep nasendoscopy for assessment of snoring with bispectral index monitoring.

Bispectral index (BIS) monitor is a neurophysiological monitoring device which continually analyses a patient's electroencephalogram during sedation and general anaesthesia to assess the level of consciousness and depth of anaesthesia. BIS monitoring, whilst performing sleep nasendoscopy (using midazolam and propofol), has helped validate depth of sedation and allowed comparison with levels of sedation of control patients during natural sleep. A prospective study of 30 patients with snoring undergoing sleep nasendoscopy with BIS monitoring was conducted. BIS monitoring was recorded throughout the procedure and assessment of snoring was made at the appropriate level of sedation and snoring. BIS values were compared with control patients. The 30 patients undergoing sleep nasendoscopy had average BIS values ranging from 50.72 to 61.2. Similar results were seen with BIS and oxygen saturation in the control group. BIS monitoring provides an adjunct to the assessment of sleep nasendoscopy in determining the level of sedation required for snoring assessment. Comparable BIS values and oxygen saturation levels were obtained between controls and patients during sedation-induced sleep, thus validating the role of sleep nasendoscopy.

Spontaneous silent sinus syndrome (imploding antrum syndrome): case series of 16 patients.

INTRODUCTION: Silent sinus syndrome (SSS) is a rare idiopathic collapse of the maxillary sinus and orbital floor. We present the second largest series of sixteen patients with SSS and describe their management. METHODS: A cohort of 16 patients with spontaneous SSS between 1999 and 2009 were reviewed at the Royal National Throat Nose and Ear Hospital. All patients were initially referred from a postgraduate ophthalmic hospital, Moorfields Hospital. RESULTS: Fourteen patients required endoscopic sinus surgery to re-establish maxillary sinus drainage and the remaining two settled with intranasal medical therapy consisting of steroids and decongestions. Follow- up ranged from 6 months to 4 years with a mean of 2.6 years. An improvement in enophthalmos and was seen in all surgically treated patients with a mean improvement of 2.2mm and range 0.5-4mm. DISCUSSION: SSS arises from congestion of the ostiomeatal complex resulting in negative pressure within the maxillary sinus and a gradual implosion of the antral cavity. Endoscopic sinus surgery successfully re-establishes maxillary aeration in our series and leads to clinical and aesthetic improvement in the degree of enophthalmos and has avoided the need for orbital floor repair in all but two cases.

British Rhinological Society audit of the role of antibiotics in complications of acute rhinosinusitis: a national prospective audit.

OBJECTIVE: Acute rhinosinusitis (ARS) is one of the most common presenting conditions to Primary Care physicians. Over-prescription of antibiotics has led to wide debate and divided expert opinion regarding the resulting increasing bacterial resistance or the merits of prevention of more serious complications of ARS. A national prospective audit was undertaken in the UK to evaluate use of antibiotics for ARS in Primary Care. METHODS AND MATERIALS: British Rhinological Society members were asked to contribute patients admitted with complications of ARS, between Feb 2008­Feb 2009 to a national prospective audit via an on-line survey. RESULTS: Seventy-eight patients were admitted with complications of ARS. The majority of patients were started on antibiotics (59%) prior to admission, with penicillin/amoxicillin being most frequently (64%) prescribed. Similar complication rates were seen in patients treated with and without prior antibiotics. CONCLUSION: Despite prior antibiotic treatment, complications of ARS seem to occur sporadically. Our study has shown that the complications which require surgical treatment are similar in both the prior antibiotic treated group and the no prior antibiotic group, suggesting limited benefit of oral antibiotics in the Primary Care setting. Early recognition with CT scanning and appropriate hospital management is essential to reduce any subsequent morbidity or mortality.

Pharyngolaryngectomy using a free jejunal graft: a new anastomosis technique.

We describe a technique of staple anastomosis for pharyngolaryngeal reconstruction using a free jejunal graft. Stapled anastomosis can be applied to both the upper and lower pharyngeal and oesophageal repair. Our series of 37 stapled anastomosis developed no post operative leaks. This technique allows an easier method for inferior anastomosis low down in the upper mediastinum where access is often difficult. Swallowing was established in all patients. Primary puncture into oesophagus below the anastomosis, gives good results with a low stricture rate of 11% all of which resolved with a single subsequent dilatation.

Health outcome measurements in children with sleep disordered breathing.

OBJECTIVE: To validate the Child Health Questionnaire, measure quality of life in children with obstructive sleep apnoea and assess the impact of surgery. METHODS: The primary carer of a consecutive series of 42 patients with sleep disordered breathing referred to a paediatric otolaryngology clinic completed the Child Health Questionnaire (version PF 28). Questionnaires were analysed for data quality and completeness, item/scale correlation, internal consistency and discriminant validity, interscale correlation and reliability. Following overnight pulse oximetry 37 children were diagnosed with obstructive sleep apnoea and underwent adenotonsillectomy. RESULTS: Child Health Questionnaire Physical Functioning 28 demonstrated excellent measuring characteristics in our population. Compared with normative data, children with obstructive sleep apnoea and their carers suffer a significant quality of life deficit, involving 10 of 13 subscales of the Child Health Questionnaire. This was most prominent in parental emotional impact, general health perception and family activities. There was no correlation between the severity of obstructive sleep apnoea and quality of life indices. Following surgery, there was a significant improvement in all Child Health Questionnaire subscales, which became equivalent to healthy children. CONCLUSION: The Child Health Questionnaire Physical Functioning 28 is an accurate and reliable way of assessing the impact of obstructive sleep apnoea on the quality of life in children in Britain. This appears to be significant in most aspects of a child's life, but is fully reversed following surgery.

Prevalence of back and neck pain amongst ENT consultants: national survey.

Back and neck pain is an established occupational disease for many professions. No previous studies have shown the association of back and neck pain with ENT surgery. Our objective was to determine the prevalence of neck and back pain in ENT consultants in the United Kingdom and which sub-specialties were most at risk. A national survey from 325 ENT consultants in the UK revealed that 72 per cent had either back pain or neck pain or even both. Of those with pain 53 per cent attributed their symptoms directly to ENT surgery. Highest figures were received from otologists, related to microscope work and prolonged sitting. The importance of these findings has demonstrated the lack of awareness and adequate training to prevent long-term disability in ENT surgeons.