The Wexham Criteria: defining severe epistaxis to select patients requiring sphenopalatine artery ligation.

This study aims to provide guidance regarding patient selection and timing of intervention with sphenopalatine artery (SPA) ligation by defining 'severe epistaxis'. An analysis of all patients undergoing SPA ligation (January 2002-2010) was performed. SPA ligation was deemed necessary if at least one of the four identified criteria was fulfilled. The same analysis was also performed on all patients admitted with epistaxis who did not undergo SPA ligation over a 6-month period. All 27 patients who underwent SPA ligation met at least one of the criteria selected. Uncontrolled epistaxis (21/27) was fulfilled most often. In comparison, only 4/71 patients admitted with epistaxis who did not undergo SPA ligation fulfilled any single criterion. All criteria were satisfied in a significantly higher number of cases in the SPA group (p < 0.001) The criteria studied proved helpful in identifying patients admitted to hospital with epistaxis who had failed conservative measures.

Alternative injectable materials for vocal fold medialisation in unilateral vocal fold paralysis.

BACKGROUND: Patients with unilateral vocal fold paralysis (UVFP) usually present with dysphonia, but can also be breathless and have problems with their swallowing. Speech and language therapy forms the initial mainstay of management in cases of UVFP, since up to 60% of cases will resolve spontaneously. If vocal fold paralysis persists surgery, in the form of injection medialisation, has been shown to be an effective intervention. What is currently unclear is which is the most effective material available for injection. OBJECTIVES: To assess the effectiveness of alternative injection materials in the treatment of UVFP. SEARCH METHODS: We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 March 2012. SELECTION CRITERIA: Randomised controlled trials (RCTs) of injectable materials in patients with UVFP. The outcomes of interest were patient and clinician-reported improvement, and adverse events. DATA COLLECTION AND ANALYSIS: Two authors independently selected studies from the search results and extracted data. We used the Cochrane 'Risk of bias' tool to assess study quality. MAIN RESULTS: We identified no RCTs which met the inclusion criteria for this review. We excluded 18 studies on methodological grounds: 16 non-randomised studies; one RCT due to inadequate randomisation and inclusion of non-UVFP patients; and one RCT which compared two different particle sizes of the same injectable material. AUTHORS' CONCLUSIONS: There is currently insufficient high-quality evidence for, or against, specific injectable materials for patients with UVFP. Future RCTs should aim to provide a direct comparison of the alternative materials currently available for injection medialisation.

How clean is your scope? A completed audit cycle of the disinfection of nasendoscopes.

INTRODUCTION: Correct disinfection of nasendoscopes is essential to address both the potential iatrogenic transmission of infection and to avoid injury from the chemicals used. MATERIALS AND METHODS: Standards-based audit of the disinfection of nasendoscopes against the ENT UK guidelines. INTERVENTION: instructional poster and staff training session. The disinfection process was re-audited one month later. RESULTS: A total of 10 sessions and 31 cleaning episodes were audited in the first cycle (C1). A total of 12 sessions and 36 cleaning episodes were re-audited in the second cycle (C2). Clinic set-up results: there was a marked improvement in the checking of the expiry date (C1=5/10; C2=10/12; P≤0.001) and recording the date for the solution to be discarded (C1=0/10; C2=10/12; P≤0.048). Each cleaning episode results: an improvement in transportation in a 'dirty bag' (C1=0/31; C2=19/36; P≤0.001), washing of the scope (C1=0/31; C2=36/36; P≤0.001), adequate disinfection time (C1=16/31; C2=33/36; P≤0.001), rinsing and drying with alcohol swab (C1=0/31; C2=35/36; P≤0.001) and placing of the scope in a 'clean bag' for storage (C1=0/31; C2=35/36; P≤0.001) was seen after the intervention. CONCLUSIONS: The introduction of a poster and training in the disinfection of nasendoscopes proved successful in improving compliance with the published guidelines. These simple measures were simple, cheap and effective to institute. The benefit of improving the disinfection of nasendoscopes to patients, doctors and the organisations that they work in is clear.

Lemierre's syndrome as a consequence of acute supraglottitis.

Lemierre's syndrome comprises internal jugular vein thrombosis following oropharyngeal sepsis and is a rare and serious condition. It is most commonly caused by the anaerobe Fusobacterium necrophorum and typically presents as metastatic sepsis to the lungs and joints. Thrombosis is demonstrated by computed tomography (CT) of the neck, and it is routinely treated with intravenous antibiotics and anti-coagulation. We describe a case of Lemierre's syndrome following acute supraglottitis. The clinical features were of retrograde intracranial thrombosis, rather than the more usual metastatic sepsis.