Nasal pemphigoid: a diagnostic dilemma.

Cicatricial pemphigoid is a chronic, systemic, immunobullous disorder affecting mucous membranes. Nasal manifestations of cicatricial pemphigoid are less common than in the rest of the upper aero-digestive tract, and may prove difficult to diagnose and manage effectively. We report one such case presenting with isolated nasal symptoms, in which diagnosis, treatment and ongoing management of the underlying cause was particularly challenging. A literature review was performed to ascertain the incidence of cicatricial pemphigoid and to establish the best evidence-based investigation and treatment.

The middle ear mass: a rare but important diagnosis.

The authors report a rare case of primary intracranial meningioma presenting as a middle ear mass with conductive hearing loss. The authors aim to highlight the importance of diagnosing a middle ear mass, which although rare, may have a substantial impact on ongoing patient management. A discussion of other middle ear pathologies is made in order to demonstrate the subtle differences in presentation.

Prospective, randomized, single-blinded study comparing the use of a flexible nasendoscope and a rigid laryngoscope in outpatient laryngeal and pharyngeal examinations.

OBJECTIVE: To compare the quality of the image obtained using a flexible nasendoscope and a rigid laryngoscope when visualizing laryngeal and pharyngeal structures in an outpatient setting. DESIGN: Prospective, randomized, single-blinded study. SETTING: Otolaryngology outpatient clinic. PARTICIPANTS: Patients referred to the otolaryngology clinic with laryngeal symptoms were prospectively recruited and subjected to laryngeal investigation using both the flexible nasendoscope and the rigid laryngoscope. The order of both instruments was randomized, and the investigations were recorded and scored according to a set protocol. MAIN OUTCOME MEASURES: Primary: score of each instrument at visualizing laryngeal structures. Secondary: tolerability of each instrument. RESULTS: Thirty patients (12 males vs 18 females) were recruited, with a median age of 43.5 years. No statistical difference was noted in terms of the tolerability of each instrument (p = .885). Both instruments were similar in terms of the structures identified. The quality of the image was better when using the rigid laryngoscope (p = .009). CONCLUSION: The flexible nasendoscope and the rigid laryngoscope were equally tolerated. The flexible nasendoscope was slightly better at visualizing the laryngeal structures, whereas the rigid laryngoscope provided better image quality.

To "EE" or not to "EE".

OBJECTIVE: To assess whether /i:/ ("ee") is the best sound to use during indirect laryngoscopy to produce the optimal view of the larynx. DESIGN: Prospective study. SETTING: District general hospital otolaryngology outpatient clinic. PATIENTS: Eighty-seven patients from a general otolaryngology clinic with no laryngeal or pharyngeal symptoms or pathology. MAIN OUTCOME MEASURES: The views obtained during indirect laryngoscopy and vocalization of /i:/ ("ee"), /ei/ ("ay"), /[see text]/ ("err"), /a:/ ("ah"), and /ea/ ("air") were graded according to a laryngoscopy grading system. RESULTS: The greatest number of adequate views of the larynx was achieved by using the sounds /i:/ and /[see text]/. There was no significant difference between /i:/ and /[see text]/ (p = .740), but there were significant differences between /i:/ and /ei/ (p = .019), /i:/ and /a:/ (p = .00000), and /i:/ and /ea/ (p = .00013). CONCLUSION: For the optimal view of the larynx during indirect laryngoscopy, we recommend the use of the sounds /i:/ ("ee") and /[see text]/ ("err").

Change in health status after rhinoplasty.

OBJECTIVE: To assess the change in health status of patients undergoing rhinoplasty. DESIGN: Retrospective mail-based questionnaire study using a validated post-intervention questionnaire specifically designed for otolaryngology surgery. SETTING: District general hospital otolaryngology department. PATIENTS: All patients (78 in total) undergoing rhinoplasty surgery between October 1998 and November 2003 were included in the study. MAIN OUTCOME MEASURE: Glasgow Benefit Inventory, a validated post-intervention questionnaire specifically designed for otolaryngologic surgery. RESULTS: The mean total Glasgow Benefit Inventory score was +20.0 (95% confidence interval [CI] 14.2-25.9), and the mean general, social, and physical subscale scores were +25.0 (95% CI 17.3-32.7), +10.2 (95% CI 4.4-16.0), and +9.9 (95% CI 2.7-17.0), respectively. CONCLUSIONS: Our results show that the health status of patients undergoing rhinoplasty improved overall and according to each of the subscales used.

A prospective randomised controlled trial comparing Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis.

A prospective study was performed to compare the efficacy and patient tolerance of Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis. A total of 42 patients were studied. There was no significant difference between the two types of pack in efficacy or patient discomfort with pack in situ. Rapid Rhino produced significantly lower scores for subjective patient discomfort during insertion and removal of pack.