Hearing aids versus ventilation tubes in persistent otitis media with effusion: a survey of clinical practice.

A postal survey was carried out to determine the current clinical practice amongst consultant otolaryngologists in the UK, regarding re-insertion of ventilation tubes or recommendation of hearing aids in cases of recurrence of otitis media with effusion (OME) after ventilation tube extrusion. Amongst the 319 respondents, 15 (4.70 per cent) routinely, 146 (45.77 per cent) sometimes, and 158 (49.53 per cent) either never, or very rarely, recommend hearing aids. Hearing aids and ventilation tubes were both suggested to be equally good options by some consultants but they preferred surgery for a number of reasons. There were inconsistencies in practice and some of the reasons for re-inserting ventilation tubes are not evidence-based. A hearing aid is a non-invasive option and this survey shows a need for a randomized control trial of hearing aids and ventilation tubes in the management of persistent and recurrent OME.

Otological complications following basal skull fractures.

A retrospective review is presented of 50 patients, with a basal skull fracture, who had radiological or clinical evidence of temporal bone involvement. The study looks at the incidence of significant otological symptoms reported during the admission and we review the subsequent patient management. We propose that all patients presenting with a head injury, and one or more of a number of symptoms characteristic of a temporal bone fracture, should automatically have an otological assessment. This will facilitate the early detection and subsequent follow up of potentially correctable middle ear disorders. We review the literature to highlight the high incidence of complications associated with these fractures.

Septal, widely infiltrative and clinically occult adenoid cystic carcinoma of the parotid gland.

Most salivary gland tumours present with an obvious mass and are usually diagnosed clinically. We present a case of occult adenoid cystic carcinoma of the parotid which, due to its peculiar septal pattern of growth and complicated clinical setting, defied diagnosis for several years.

An unusual complication of T-tubes.

The morbidity of long-term ventilation tubes (Goode T-tubes) is often discussed with reference to otorrhoea, tympanosclerosis and long-term perforation. We report three cases of the T-tube slipping into the middle-ear cleft. In two of the three patients this was asymptomatic and the T-tubes were left in situ. In the third patient this complication was documented on three occasions when the T-tube was removed and reinserted for recurrent effusions. We are unaware of this complication being previously reported in the literature.

Systemic absorption of gentamicin ear drops.

Aminoglycoside-containing topical preparations are commonly used in the treatment of chronic suppurative otitis media and otitis externa. We report a case where systemic absorption of topical Gentisone HC occurred producing a serum gentamicin level of 6.2 micrograms/ml.

Dysphagia caused by a hard cervical collar.

It is important to consider unusual neck anatomy when fitting hard cervical collars after neurosurgical procedures. A collar which fits too tightly may restrict laryngeal movement during swallowing causing dysphagia, which could be mistaken for damage to neuromuscular function in this group of patients.

Pneumoparotitis, subcutaneous emphysema and pleomorphic adenoma.

Self-induced pneumoparotitis is a distinct clinical entity which should be considered in any inflammatory swelling of the parotid gland. When complicated by subcutaneous emphysema, other more important causes should be excluded. An unusual case is presented, which was further complicated by the presence of a pleomorphic adenoma.

Intralabyrinthine schwannoma.

Intralabyrinthine schwannomas are rare tumours which present with symptoms similar to Menière's disease. Preoperative diagnosis is rarely possible and most are found incidentally during labyrinthectomy for persistent vertigo. A further case of this tumour is reported together with a review of the literature.

Otogenic Fusobacterium necrophorum meningitis.

A case of meningitis secondary to acute suppurative otitis media in a previously healthy child is reported. The only organism isolated from blood after aerobic and prolonged anaerobic culture was identified as Fusobacterium necrophorum. Complete recovery followed treatment with surgery and prolonged antibiotic therapy. The role of anaerobes in the development of meningitis, the isolation and identification of Fusobacterium necrophorum, the clinical presentations of F. necrophorum infection and the choice of antibiotics in the treatment of these infections are discussed.

Infant tracheotomy--endoscopy and decannulation.

The records of 73 infants aged 24 months or less who underwent tracheotomy in a 10-year period were reviewed. Two common problems before decannulation were granulations and suprastomal collapse of the anterior tracheal wall above the internal stoma. There were no decannulation failures which could not be accounted for by the primary airway problem. There was no evidence of unexplained "dependence" on the tracheotomy. The results confirm that tracheotomy in the infant patient can be safe both short-term and long-term. There has been no similar long-term review of tracheotomy in small infants indicating the place of endoscopy and the technique of decannulation.

Oestrogen and progesterone receptors in acoustic neuroma.

Tissue samples from fourteen consecutive (8 male: 6 female) acoustic neuromas were assayed for hormone receptors using either a monoclonal antibody (MA), dextran coated charcoal (DCC) or isoelectric focusing (IEF) technique. In this series there were no unequivocally positive results, a finding at variance with previously published results.

Incidence of abnormality in routine 'vocal cord checks'.

Where elective surgery carries a risk of damage to the recurrent laryngeal nerve, pre-operative examination of the larynx is routine. The incidence of positive findings at such examination has been determined by retrospective review of 1,947 clinic records. Only 31 vocal cord palsies were found. The possible causes and relevance of such findings are discussed.

Some complications of tracheo-oesophageal puncture for voice restoration.

Tracheo-oesophageal puncture for voice restoration is now a commonly performed operation. Little has been written about the complications of this procedure. In this report, complications such as septicaemia, cellulitis, respiratory obstruction, mediastinitis and paravertebral abscess are described. The incidence of these complications can be reduced by bearing in mind the distorted anatomy in the post-laryngectomy neck.

Rationalization of peritonsillar abscess as an indication for tonsillectomy.

It has been widely held that peritonsillar abscess is a strong, if not absolute, indication for tonsillectomy, performed either immediately or after an interval of some weeks. A retrospective study of 48 patients is presented. It appears that age and the incidence of previous throat infections can be related to the likelihood of further problems and the need for operation.

The consequences of delay in tonsil surgery.

A prospective study was designed to determine whether there is any morbidity caused by the delay of tonsil surgery while patients are on long waiting lists in the United Kingdom. It was found that, far from being harmful, a long waiting list allows one in five children to "grow out" of their problems, saving 20 per cent of patients from unnecessary surgery.

Grommet insertion: some basic questions answered.

A very large number of grommets are inserted to improve middle ear ventilation in children. A retrospective survey of 1011 admissions for myringotomy and/or grommet insertion has been used to answer some basic questions about such admissions and the fate of grommets inserted. No attempt has been made to assess the benefits of this mode of treatment. The average number of admissions per child was 1.6, with 64% being admitted only once. A child aged 3-4 years when first listed had the greatest chance of repeated admissions. Nearly 50% of the grommets had been extruded within 6 months and 80% within 1 year. Children put on the waiting list because of middle ear effusions present in summer months had a greater chance of spontaneous resolution in the subsequent few months than those listed in winter months. Significant complications occurred in 2.2% of grommet insertions.

Respiratory obstruction following vocal cord injection of Teflon paste.

Injection of poly(tetrafluoroethylene) past (Teflon) into vocal cords is becoming more common, but immediate morbidity has not previously been described. A case is reported in which acute airway obstruction followed the injection of Teflon paste into a paralysed vocal cord. This was easily managed, without resort to tracheostomy, by topical lignocaine which reduced the overactivity of the normal vocal cord.