Single dose injection snoreplasty: investigation or treatment?

INTRODUCTION: Many surgical and nonsurgical procedures have been designed for the treatment of snoring due to palatal flutter. All work in some, but not all, snorers. The difficulty lies in making the definitive diagnosis of palatal flutter as the cause of snoring, and in deciding which patients should undergo which treatment, which in some cases are relatively radical. AIMS: This study aimed to assess the usefulness of injection snoreplasty in differentiating palatal flutter from other forms of snoring. This was done in the hope of determining which patients would benefit from definitive palatal surgery such as uvulopalatopharyngoplasty and laser-assisted uvuloplasty. MATERIALS: Sixty consecutive patients referred for habitual snoring were treated with sodium tetradycil sulphate during their first consultation visit. No patients were excluded and none refused the treatment. Forty patients received a single 1 ml dose of 1 per cent sodium tetradycil sulphate, and twenty patients received a single 1 ml dose of 3 per cent sodium tetradycil sulphate under topical anaesthesia. Visual analogue snoring scales were completed by the patient and their partner six weeks, three months, six months and 12 months after the procedure. RESULTS: Forty of the 60 patients showed improvement in snoring and therefore were considered for definitive surgery. Four of the 60 patients found the investigation unpleasant and did not want any further treatment. Of the 40 patients who showed improvement, 29 maintained this at one year. The other 11 underwent uvulopalatopharyngoplasty or laser-assisted palatoplasty. All patients had successful snoring scale outcomes following the surgery. CONCLUSION: A significant number of the patients, 62 per cent, were demonstrated to have significant improvement in the short term. Single dose injection snoreplasty seems not only to be an effective investigation but may constitute a safe and simple treatment within the clinic. At the very least, patients in whom the palate appears not to be the problem are prevented from undergoing painful, unpleasant surgery. Our results support the use of injection snoreplasty, both as an investigation and in some patients as a treatment, for habitual snoring.

Persistent nasal crusting due to hypohidrotic ectodermal dysplasia.

Hypohidrotic ectodermal dysplasia is an hereditary condition of the ectodermal tissues which may escape recognition because of lack of clinical awareness due to its rarity. Otorhinolaryngological features of this syndrome include chronic respiratory tract infections, persistent foul-smelling nasal discharge and crust formation, and hearing problems. The condition is usually an X-linked recessive disease affecting mainly ectodermal tissue, although nonectodermal tissue may also be affected. The notation 'ectodermal' is used because ectodermal tissues are always involved. The syndrome is characterized by complete or partial absence of sweat glands, sparse hair growth, absent or deformed peg teeth, sparse sebaceous glands, occasional absence of salivary and lacrimal glands, scanty mucous glands and deficient cilia. We describe two children with this disorder with specific reference to the effect on the upper respiratory tract.

Day case surgery in otolaryngology: the setting up and first year of a freestanding unit.

A freestanding day case surgery unit for ENT cases is described and the first year's experience reviewed. Special attention is paid to the variety, and complications, of surgery as the freestanding unit is 17 miles from the main ENT centre. The difficulties of running the unit are reviewed. The problems encountered include arranging training for the staff and maintaining optimum throughput of cases. Consideration is also given to the setting up and running costs of the unit. Four hundred and seventy-seven patients were treated from 46 lists. This accounted for 64 per cent of the total number of patients having ENT surgery in 1992 from our area.

Influence of season and microclimate on fertility of dairy cows in a hot-arid environment.

Records were obtained over a 3 year period from six Holstein dairy farms of 300 to 500 cows each in the Phoenix, Ariz. area. Dairies were selected on the basis of similar management practices, herd size, milk production and facilities (with the exception of cooling systems). Microclimatic modifications (two dairies each) were shade only (approximately 3.7 m2/cow), evaporative-cooled shades and low-pressure water foggers under the shades. Data were categorized by season of calving (spring, Feb.-May; summer, June-Sept.; and fall, Oct.-Jan.). Traits evaluated were calving interval, days open and services/conception. Calving interval was shortest for cows calving in the spring (378 days), intermediate in fall (382 days) and longest in summer (396 days). Similar seasonal trends were observed for days open (103, 103 and 119 days, respectively) and services/conception (1.54, 1.81 and 1.93, respectively). All differences between spring and summer were significant (P less than 0.05). Calving interval and days open were less for evaporative-cooled groups (374 and 98 days, respectively), with no difference between shade only and foggers (391 and 392 days, 112 and 116 days, respectively). Services/conception were similar for all groups (1.72 to 1.79). A significant interaction between microclimate and season for services/conception could be interpreted as (i) smaller season differences for evaporative-cooled groups than for shade or foggers, or (ii) a change in the ranking of control and fogger groups during summer versus fall. Evaporative cooling was more effective than fogging for reducing the detrimental effects of seasonal high temperatures on fertility.

The use of Walkman Mini-stereo system as a tinnitus masker.

A study was done on 41 patients to compare the use of the Walkman Mini-stereo system with different types of phones to mask tinnitus, by using music, or relaxation or different bands of noise similar to those generated by a tinnitus masker or pure tone, and it was found that the Walkman Mini-stereo system with any types of phone, was as effective, and more economic, both to patients and to the N.H.S., than traditional tinnitus maskers. It should be recommended for the management of tinnitus in preference to the traditional tinnitus maskers.

The use of the Walkman mini-stereo system in the management of tinnitus.

The Walkman mini-stereo system was tried on 50 patients who had tinnitus and 86.7 per cent of the patients found it effective and useful. In spite of the few minor disadvantages, its use is recommended, at least before prescribing an expensive tinnitus masker.

Cervical ganglioneuroblastoma.

A case of primary cervical ganglioneuroblastoma is reported. It is a very rare tumour, only one example of this differentiated form of neuroblastoma having been previously recorded as a primary tumour in the neck. The incidence, clinical features, pathology and prognosis of primary cervical neuroblastoma have been discussed.