A prospective evaluation of foreign bodies presenting to the Ear, Nose and Throat Clinic, Hospital Kuala Lumpur.

The results of a prospective study of 94 patients with history of ear, nose or aerodigestive tract foreign bodies were analysed. Sixty six to 94% of patients presented within 24 hours to a primary care doctor, 80 to 94% was referred to the ENT Department within 24 hours and 89 to 93% of patients had their foreign bodies removed within 24 hours. Overall, 58% of aural foreign bodies, 67% nasal foreign bodies and 94% of aerodigestive tract foreign bodies were removed within 48 hours of insertion. As a result of the prompt removal of foreign bodies in the majority of patients, no significant complications occurred. Foreign bodies in the aerodigestive tract tend to present earlier and more promptly removed compared with ear and nose foreign bodies. There was a significantly higher proportion of foreign body in the right ear and nostril compared to the left.

The role of endoscopic stapling diverticulotomy in recurrent pharyngeal pouch.

Endoscopic stapling diverticulotomy is an increasingly popular treatment option for pharyngeal pouch. It has been our treatment of choice for the condition for over three years. Of the over 50 cases treated using the technique, three were performed for recurrent pouches--two following previous endoscopic stapling diverticulotomy and one following previous external excision. We describe these three cases to highlight the advantages and effectiveness of the technique in recurrence cases.

Current practice in pharyngeal pouch surgery in England and Wales.

A survey of the current surgical practice for patients with a pharyngeal pouch was conducted among general surgeons, otolaryngologists and cardiothoracic surgeons in England and Wales. Our results show that while pouch excision remains the most common method used, endoscopic stapling diverticulotomy is rapidly being adopted. The reasons why this recently introduced technique is likely to become the definitive treatment of pharyngeal pouch are discussed.

Endoscopic stapling diverticulotomy for pharyngeal pouch.

Fifteen endoscopic stapling diverticulotomy procedures were performed on 14 patients. Our preliminary results show the technique to be fast. effective and safe. Most patients resumed oral intake within 6 h post-operatively and were discharged from hospital within 24 h. The technique has many advantages over both the external diverticulectomy and the traditional Dohlman's procedure. The short operating time and short hospital stay are an advantage. Our follow-up period was between 1 and 12 months. Long-term results require evaluation.

First aid treatment of epistaxis--are the patients well informed?

OBJECTIVE: To investigate the level of lay knowledge of first aid measures for epistaxis, and to determine the effectiveness of an ENT department policy of providing an advice sheet of first aid measures. METHODS: 50 patients presenting with epistaxis were questioned on the accuracy and level of their knowledge of the four basic procedures used to combat a nose-bleed. The results were correlated with the source of referral, previous treatment, and advice. RESULTS: A large proportion of patients who had previously been treated for epistaxis by their general practitioners and other non-ENT trained medical or nursing staff were unable to recall being given any first aid advice. For those who remembered being given advice, very few described all the steps correctly. In contrast, patients who had previously been seen by the ENT staff scored full points in every aspect. CONCLUSIONS: The results are a reflection of the departmental policy of supplying information sheets outlining the first aid measures to all patients presenting with epistaxis.

Direct hearing aid referrals: a prospective study.

General practitioners from a designated catchment area were invited to participate in a direct hearing aid referral project and were issued with a standard referral form outlining the criteria for referral. A total of 175 patients was referred with a fully completed referral form and were initially assessed by a senior audiology technician or higher grade. A total of 135 patients (77%) was suitable for hearing aid fitting and 40 (23%) were considered to be inappropriate referrals, of which 17 (9.7%) required further referral for an ENT opinion. For the purpose of safety, each patient was independently examined by an ENT doctor. The management decisions of the audiology technicians were in total agreement with those of the ENT doctors. Our results also suggested that patients below the age of 60 are generally unsuitable for direct referral.

Endoscopic stapling diverticulotomy of pharyngeal pouch.

Endoscopic diverticulotomy (Dohlman's procedure) is a well-established and effective alternative to external diverticulectomy in the treatment of pharyngeal pouch. The division of the common septum between the pouch and the oesophagus is usually performed either with electrocautery or with a laser. We describe a new technique of endoscopic diverticulotomy using a linear cutter stapling gun. This technique has the advantages of being quick and bloodless, avoiding the need for a nasogastric tube, permitting oral intake as early as the first postoperative day and allowing early discharge from hospital. It also has the theoretical advantage over the electrocautery or the laser technique of reducing the risk of fistula formation, mediastinitis and thermal injury to the recurrent laryngeal nerve.

A nurse-led preadmission clinic for elective ENT surgery: the first 8 months.

A nurse-led preadmission clinic was set up in the Department of Otolaryngology of The Royal Berkshire Hospital, Reading, for patients undergoing elective ENT surgery. The progress of the clinic has been monitored during its first 8 months of service. A two-part study was undertaken: (a) A prospective study of the process from the time an admission appointment was sent until completion of surgery and, (b) a retrospective review of the case notes to study the quality of clerking and note keeping and the pattern of requests for investigations made by the nurses. In all, 514 patients were invited to attend the preadmission clinic before operation. Of these patients, 454 attended the clinic for preadmission clerking, 440 (96.9%) of whom underwent their operation without complication. All clerking notes were well kept, but a number of unnecessary investigations were requested. It is concluded that a nurse-led preadmission clinic is effective in the management of elective ENT operating lists. It assists in improving the quality of an SHO's training by reducing time spent on service commitments, thereby increasing the potential training time. More guidance to nurses on the use of preoperative investigations is needed.

Lemierre syndrome--a forgotten complication of acute tonsillitis.

Lemierre syndrome, also known as postanginal sepsis, is an illness characterized by the development of a fusobacterial septicaemia with multiple metastatic foci following an attack of acute tonsillitis. It typically affects previously healthy adolescents and young adults who, following an attack of sore throat, become acutely ill with hyperpyrexia, rigors and multiple metastatic abscesses. The clinical picture tends to vary widely because of the possible involvement of a number of body systems and organs in the disease process. This serious complication of oropharyngeal sepsis had a mortality rate in excess of 90 per cent in the pre-antibiotic era. Although now rarely seen and often forgotten, it remains a potentially life-threatening condition. We present four cases of post-tonsillitis fusobacterial septicaemia to illustrate the variability of the clinical presentation and stormy clinical course frequently associated with this rare syndrome.

Nasendoscopy guided removal of fish bones from the base of tongue and the vallecula.

Impaction of a fish bone at the base of tongue or the vallecula is a very common problem. Removal of the bone from these sites without a general anaesthesia can be challenging to surgeons and patients alike. Various manoeuvres to facilitate this procedure have been described, some are very successful but may require specialized instruments, while others may cause excessive discomfort to the patients and even inadvertent dislodgement of the bone. We describe a method using a flexible fibreoptic nasendoscope to provide a visual guide in order to facilitate peroral removal of the bone with a pair of forceps. This method is well tolerated by patients and avoids the need for a general anaesthesia in many cases.

Giant cell reparative granuloma of the concha bullosa.

Giant cell reparative granuloma is a benign lesion occurring most commonly in the bones of the jaw and rarely in the paranasal sinuses. We present an unusual case of giant cell reparative granuloma arising within a concha bullosa. Complete excision was achieved using an endoscopic transnasal approach.

An unusual presentation of an unusual complication of infectious mononucleosis: haematemesis and melaena.

Tonsillar haemorrhage is a rare complication of infectious mononucleosis. We present a case of life-threatening tonsillar haemorrhage secondary to infectious mononucleosis in a young man whose predominant symptoms at presentation were haematemesis and melaena. The origin of the haemorrhage was not obvious until the patient was examined under anaesthesia. The bleeding was controlled by emergency tonsillectomy.

Chondromyxoid fibroma of the nasal bone with extension into the frontal and ethmoidal sinuses.

Chondromyxoid fibroma is a rare benign tumour whose histological appearance may easily be misinterpreted as chondrosarcoma. It has a tendency to recur locally unless completely excised. A rare case of the tumour affecting the nasal bone with extension into the frontal and ethmoidal sinuses and impingement on the cribiform plate is presented. Complete excision was achieved by the craniofacial resection approach.

Short- and long-term outcomes of uvulopalatopharyngoplasty for snoring.

Uvulopalatopharyngoplasty is a well established and highly successful operation in the treatment of snoring. However, most published data are based on relatively short-term follow-up results. Anecdotal cases of late recurrence of snoring after an initially successful surgical result have been reported but few formal studies have been performed to determine the true magnitude of this problem. We compared the short-term and long-term results on our patients and found the late recurrence rate after a minimum follow-up period of 12 months (range: 12-84 months, mean 31.3 months) to be in the region of 13%. The risk of recurrence was directly related to the body mass index.

Adenocarcinoma arising in an oesophageal colonic interposition graft.

This case report describes the rare complication of an adenocarcinoma developing in a colonic interposition graft 20 years following surgical resection of a postcricoid squamous carcinoma. A free jejunal graft was used for further oesophageal reconstruction following resection of the colonic graft.