ABSTRACT
INTRODUCTION: After treatment of epistaxis, patients are routinely supplied with an intranasal bactericidal cream containing neomycin. Neomycin cream is effective in preventing recurrent paediatric epistaxis. This study aimed to assess whether there is an increased rate of nasal bacterial infections in adult epistaxis patients. METHODS: Between October 2004 and April 2005, nasal swabs were taken from adult patients presenting with epistaxis, and from a control group comprising elective ENT patients. RESULTS: There were 23 controls and 26 epistaxis patients. Staphylococcus aureus was grown in 21 per cent and 23 per cent, respectively. There was no significant difference in bacterial carriage rates between the epistaxis and control groups. CONCLUSIONS: The epistaxis and control groups demonstrated the same bacterial species and the same proportion of bacterial carriage. Although the majority of bacterial species encountered were sensitive to neomycin, a significant proportion was not. These results do not support the routine use of neomycin in the prevention of recurrent adult epistaxis.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Carrier State/drug therapy , Epistaxis/microbiology , Neomycin/therapeutic use , Staphylococcal Infections/drug therapy , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Epistaxis/drug therapy , Humans , Middle Aged , Secondary Prevention , Staphylococcal Infections/prevention & control , Treatment Outcome , Young AdultABSTRACT
OBJECTIVES: To describe the use of the great auricular nerve as a 'road map' for locating the accessory nerve in the anterior and posterior triangle, in comparison with other methods described in the literature. DESIGN: A review of the literature using Medline and Embase searches was performed. Illustrative photographs were taken from consenting, elective patients. RESULTS: Various methods have been described, using different anatomical landmarks. We describe a new method, based on the fact that the great auricular nerve runs, with relation to the edges of the sternocleidomastoid muscle, 1 cm superior to the accessory nerve anteriorly and 1 cm inferior posteriorly. CONCLUSIONS: This is a reliable and safe method, used by the senior authors in their extensive work as head and neck and skull base surgeons. It allows the accessory nerve to be located in both the anterior and posterior triangle. This avoids the inherent dangers of following the nerve's tortuous course through the sternocleidomastoid.
