ABSTRACT
Antibiotic-resistant bacteria are increasingly common and present a major problem for the modern day ENT surgeon. This article reviews the development of methicillin resistance in Staphylococcus aureus and how it has come to affect ENT practice. We look at the evidence behind measures taken to help deal with methicillin-resistant Staphylococcus aureus (MRSA) and to prevent its spread. We go on to suggest a departmental guideline for infection control, which we hope can be implemented to help deal with the problems created by MRSA.
Subject(s)
Methicillin Resistance , Otolaryngology , Staphylococcal Infections/prevention & control , Staphylococcus aureus , Surgical Wound Infection/prevention & control , Cross Infection/microbiology , Cross Infection/prevention & control , Humans , Infection Control , Preoperative Care , Staphylococcal Infections/diagnosis , Surgical Wound Infection/microbiologyABSTRACT
To investigate a suspicion that many ear, nose and throat patients have unfounded concerns about cancer, we questioned 50 patients who had attended a routine clinic after screening-out of those with possibly cancer-related features. None of the 50 proved to have cancer. 15 (30%) had been worried about cancer and 7 of these were still worried despite the consultation. Unwarranted fears about cancer are best dealt with by the referring clinician, especially when the wait for an appointment will be long. Such fears also need to be recognized and addressed by the specialist.
Subject(s)
Anxiety , Fear , Head and Neck Neoplasms/psychology , Otorhinolaryngologic Diseases/psychology , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Otolaryngology , Otorhinolaryngologic Diseases/diagnosis , Outpatient Clinics, Hospital , Outpatients , Pilot Projects , Surveys and Questionnaires , Waiting ListsABSTRACT
BACKGROUND AND OBJECTIVES: To compare the efficacy and safety of inferior turbinate reduction in children using Holmium:YAG (Ho:Yag) laser and diathermy. Histological effects of these treatments on turbinate tissue are also studied. STUDY DESIGN/MATERIALS AND METHODS: A retrospective review and structured telephone interview of paediatric cases treated with Ho:Yag laser and diathermy to inferior turbinates. The complications, morbidity and efficacy were quantified. Histological sections of inferior turbinates treated with diathermy (surface and submucosal) and laser were compared. RESULTS: Efficacy in the laser (n = 8) and diathermy group (n = 11) was similar. The complication/morbidity score was lower in the laser group, 1.92 versus 3.48, (P = 0.04, CI: 0.01, 2). Long-term benefit was 50 and 36% in the laser and diathermy group respectively. Histology showed very limited tissue damage in all methods of treatment. CONCLUSIONS: Ho:Yag laser treatment is equally efficacious, but causes less complications and morbidity compared to surface diathermy. Both treatment methods have poor long-term efficacy, which may be related to limited tissue damage.
Subject(s)
Electrocoagulation/methods , Laser Therapy/instrumentation , Nasal Obstruction/surgery , Turbinates/surgery , Adolescent , Child , Female , Humans , Hypertrophy/etiology , Male , Nasal Obstruction/etiology , Retrospective Studies , Rhinitis/complications , Treatment Outcome , Turbinates/pathologyABSTRACT
OBJECTIVE: To report the results of endoscopic laser-assisted dacryocystorhinostomy in anticoagulated patients. STUDY DESIGN: A retrospective study of 16 consecutive anticoagulated patients with distal nasolacrimal duct obstruction treated by endoscopic laser-assisted dacryocystorhinostomy. METHODS: A case note review was made of all patients treated with endoscopic laser-assisted dacryocystorhinostomy who were taking coumadin in two centers between 1993 and 2000. The parameters of age, gender, indications for surgery, surgical findings, complications, and outcome were analyzed. The mean follow-up time was 14 months (range, 9-26 mo). RESULTS: Fifteen of the 16 patients who were treated had an eventual successful outcome, but 6 patients required revision surgery. The patient whose symptoms were not improved was shown to have functional epiphora. No patient had a problem with primary or secondary epistaxis, and no patient required admission. A major benefit was the lack of disruption of anticoagulant therapy. CONCLUSIONS: Endoscopic laser-assisted dacryocystorhinostomy is a safe, efficient technique for the relief of distal nasolacrimal duct obstruction in anticoagulated patients. Not only does it avoid any disruption to their anticoagulant therapy, but it also can be performed as an outpatient procedure.
Subject(s)
Anticoagulants/adverse effects , Dacryocystorhinostomy , Endoscopy , Laser Therapy , Warfarin/adverse effects , Adult , Aged , Ambulatory Surgical Procedures , Anticoagulants/therapeutic use , Female , Follow-Up Studies , Humans , Lacrimal Apparatus Diseases/blood , Lacrimal Apparatus Diseases/surgery , Lacrimal Duct Obstruction/blood , Male , Middle Aged , Postoperative Complications/blood , Postoperative Complications/etiology , Postoperative Complications/surgery , Reoperation , Risk Factors , United Kingdom , Warfarin/therapeutic useABSTRACT
Over the past 3 years we have treated 4 patients with nasolacrimal duct obstruction secondary to sarcoidosis. These patients have had mixed outcomes following endonasal laser-assisted dacryocystorhinostomy (DCR). A literature search from 1966 to the present yielded a further 11 cases of patients thought to have sarcoid who underwent DCR. The outcome of these 15 patients indicate that while all were initially successful, the subsequent failure rate is high. These patients are older than the majority of patients with sarcoidosis and there is a female preponderance. Systemic steroids reversed obstruction in one patient. We recommend nasal examination in all patients with nasal symptoms in whom DCR is proposed to help identify sarcoidosis or other intranasal disease and/or to allow treatment of specific diseases prior to surgery.