Rare post-tonsillectomy complication in human immunodeficiency virus positive patient: ulcero-necrotic lesion of tonsillar fossa.

OBJECTIVE: Post-tonsillectomy complications are common. The majority are easily recognised because of their frequent occurrence and can be managed as required. Infrequent complications may be misdiagnosed or managed inappropriately. We present a previously unreported complication of tonsillectomy. CASE REPORT: A 45-year-old Afro-Caribbean man underwent routine tonsillectomy. Eight weeks post-operatively, he developed an ulcero-necrotic lesion of the tonsillar fossa. Subsequent investigation revealed that he was human immunodeficiency virus positive. It is highly likely that the patient's underlying immuno-compromised state, secondary to human immunodeficiency virus infection, contributed to this ulcero-necrotic lesion. CONCLUSIONS: This case highlights the importance of clinician awareness of rare complications of tonsillectomy, in order to facilitate identification and appropriate investigation.

The 'parent's kiss': an effective way to remove paediatric nasal foreign bodies.

INTRODUCTION: The objectives of this study were to: (i) evaluate the effectiveness of 'parent's kiss' as a technique for removal of nasal foreign bodies in children; and (ii) determine whether this technique reduces the number of children requiring general anaesthesia for their removal. PATIENTS AND METHODS: This was a prospective observational study in the accident and emergency and ENT departments at Luton and Dunstable Hospital. The participants were 31 children with nasal foreign bodies, under the age of 5 years, presenting via the acute services over a 6-month period. The primary outcome measured was successful removal of nasal foreign body with the 'parent's kiss' technique. Secondary outcome was reduction in the number of general anaesthetics following introduction of the technique. RESULTS: The technique was successful in 20 out of the 31 children (64.5%) in the study group. Only one patient required general anaesthesia for removal of nasal foreign body (3%). This compares with a rate of 32.5% requiring removal under general anaesthetic in the preceding 6-month period. The 'parent's kiss', when not successful, seemed to improve the visibility of the foreign body making their subsequent removal easier. CONCLUSIONS: The 'parent's kiss' is an effective technique. It is non-traumatic, both physically and emotionally, for the child subjected to it. We advocate that it should be used routinely as a first line of management in children with a nasal foreign body in the primary care setting.

Bitter sweet tympani.

During cholesteatoma surgery, the chorda tympani nerve must often be divided. We present an interesting case of a patient whose severe dysgeusia due to cholesteatoma resolved following section of the chorda tympani nerve.

Salivary gland choristoma of the middle ear.

A salivary gland choristoma is an extremely uncommon tumour in the middle ear space. It appears to be a developmental abnormality and may be associated with abnormalities of adjacent structures. It usually presents with unilateral conductive deafness which may be long-standing and the tumour often pursues a benign, slow growing course. It is usually possible to excise it, but problems may arise as there may be variable associated anatomical abnormalities of the middle ear. We present the nineteenth recorded case, review the literature and discuss the management of this condition.

Haemangiopericytoma of the nose and paranasal sinuses.

The uncertain course and rarity of haemangiopericytoma in the nose and paranasal sinuses has interested both pathologists and clinicians. This tumour arises from proliferation of pericytes which invest capillary endothelium. A benign course is more common in the nose and paranasal sinuses. The first nasal haemangiopericytoma was reported by Stout in 1949. Since then only twenty cases have been reported in the literature. We present three further cases.