Pediatric myringoplasty: definition of "success" and factors affecting outcome.

INTRODUCTION: Recent studies have reported a high success rate of pediatric myringoplasty, but their definition of success and length of follow-up vary widely. Authors debate whether the success of a pediatric myringoplasty should be defined purely by an intact tympanic membrane or should analysis of middle ear health and audiometric data also be included. For the purposes of this study, success was defined as an intact tympanic membrane at 12 months postsurgery without evidence of effusion and preservation of hearing. OBJECTIVES: To determine the true success rate of myringoplasty and identify any independent factors that significantly influence outcome. MATERIALS AND METHODS: This was a retrospective analysis of 132 myringoplasties performed at Birmingham Children's Hospital. Cases were grouped into those children aged younger than 8 years and those aged 8 years and older. RESULTS: An intact tympanic membrane was present in 80.0% of cases at the first postoperative visit. However, at 12 months, the previously defined success rate, cases decreased to 67.3%. Younger age (p < 0.0047) and anterior perforations (p <0.0038) were the only factors found to be associated with a poorer outcome. CONCLUSION: The true rate of success of a pediatric myringoplasty would seem to be lower than rates commonly quoted to parents, and this finding is in keeping with other otologists using a similar definition of success. Younger age at the time of surgery and anterior perforations have a less successful outcome. These findings are important when counseling/consenting carers of younger children about to undergo a myringoplasty.

Amelanotic melanoma presenting with cervical lymphadenopathy.

We present a rare case of an amelanotic melanoma of unknown primary presenting with cervical lymphadenopathy. A 20-year-old man presented with large left sided neck lump, associated dysphagia and weight loss. Examination revealed a hard mass in the left posterior triangle of neck and sacral sensory loss. Fine needle aspiration cytology of the mass suggested a poorly differentiated carcinoma. Computed tomography showed a left sided, 8×13 cm cervical mass with liver, lung and bony metastases. Histological examination of the lymph nodal mass confirmed the diagnosis of a metastatic amelanotic melanoma. The patient was treated with glucocorticoids, radiation therapy for the sacral bony deposit, and chemotherapy. Despite an initial reduction of his target lesions, his condition subsequently deteriorated and he died 4 months after diagnosis.

Medical and surgical complications of the second 100 adult cochlear implant patients in Birmingham.

One hundred consecutive adult cochlear implant patients, numbered 101 to 200 in an ongoing series, were prospectively monitored and data collected using the same protocol as for the first 100 patients. The study period was 1999 to 2001. The total number of procedures was 122. Changes in practice following the first 100 implants included a standard surgical technique with a smaller incision and lesser flap mobilization, and routine facial nerve monitoring. As far as was practicable, the same commercial type of implant was used. There were 111 (91 per cent) implantation episodes, five (4 per cent) explantation episodes, four (3.3 per cent) reimplantation episodes and two (1.6 per cent) revision procedures. Eighty-nine patients underwent unilateral implantation and 11 underwent bilateral implantation. Major complications included flap breakdown (1.6 per cent), extrusion of electrode array (0.8 per cent) and device failure (0.8 per cent). The overall major complication rate was 3.2 per cent (4/122). The overall minor complication rate was 18 per cent. In addition, 7.3 per cent experienced transient vertigo and 5.7 per cent experienced local discomfort lasting three days on average with complete resolution. The overall complication rate in the second 100 implant patients was lower than in the first 100. Smaller incision and lesser flap mobilization reduced the minor complication rate.

Operative training in otolaryngology in the United Kingdom: a specialist registrar survey.

OBJECTIVE: To assess the current status of operative training for otolaryngology specialist registrars in the United Kingdom. DESIGN: Web-based questionnaire survey. PARTICIPANTS: All otolaryngology specialist registrars in the United Kingdom. MAIN OUTCOME MEASURES: The overall satisfaction with operative training was assessed as well as the number of operations performed and level of competency in stage-specific procedures, as defined by the Joint Committee for Higher Specialist Training. RESULTS: Otolaryngology specialist registrars are generally satisfied with the quality of their operative training. The most important predictive factor of satisfaction with operative training was the number of theatre sessions per week. The vast majority of registrars (92 per cent by the end of year one, 73 per cent at the end of years two to four) appear to attain all the stage-appropriate surgical competencies during the first four years. However, with respect to the last two years of registrar training, only 26 per cent can perform all the designated (complex) procedures. There are no significant differences between deaneries or geographic regions in the overall satisfaction rates, number of operative sessions, number of operations performed or operative competencies attained. CONCLUSION: It appears that the Specialist Advisory Committee (SAC) is generally successful in maintaining common operative training standards and providing a homogenous training environment. During the first four years registrars attain an appropriate level of general training while the last two years are mainly devoted to subspecialty interests.

Occult bronchogenic carcinoma presenting as metastasis to the site of a bone anchored hearing aid.

The first report of a patient with metastatic bronchogenic carcinoma of the skin surrounding the abutment of a bone anchored hearing aid (BAHA) is presented. Complications of bone anchored hearing implantation have been well documented to date. We present a 68-year-old lady who presented with an unusual skin lesion surrounding the abutment of her BAHA. This was the first presentation of her bronchogenic tumour. We also review the literature regarding cutaneous metastasis and complications of BAHA.

A cervical bronchogenic cyst in an adult.

An unusual case of a bronchogenic cyst arising in the retrosternal region and presenting as a midline neck cyst in an elderly patient is reported. These cysts are rare congenital anomalies found more commonly in the thorax in a paediatric population and very rarely present in the adult age and in the neck.