Insertion of a tracheoesophageal speech valve: a novel approach in a difficult situation.

BACKGROUND: Functional voice rehabilitation is becoming increasingly important following total laryngectomy and pharyngolaryngectomy. Tracheoesophageal voice via a shunt valve is currently regarded as the 'gold standard' for voice rehabilitation. Traditional techniques usually allow for the replacement of valves in the out-patient setting; however, patient factors such as altered anatomy may occasionally prevent this. OBJECTIVE: This paper describes a novel approach for speech valve insertion that is safe, quick and cost-effective, and which uses equipment commonly available in ENT wards and the operating theatre.

Laryngopyocoele: simple management of an acute airway crisis.

OBJECTIVE: We present the first reported case of ultrasound-guided aspiration of a laryngopyocoele in a patient with acute airway obstruction. CASE REPORT: A 71-year-old woman was diagnosed with a right-sided laryngocoele. Six weeks later, the patient was admitted as an emergency with a three-day history of increasing dyspnoea and stridor. Neck examination revealed a large, right-sided, soft neck mass, centred at level III, measuring approximately 10 x 5 cm. Fibre-optic laryngoscopy revealed a large, smooth, inflamed, right supraglottic mass obscuring the laryngeal inlet. The patient was taken directly to the radiology department, where ultrasound imaging confirmed a laryngopyocoele. Under ultrasound guidance, a 21-G needle was directed into the cyst and 30 ml of pus was aspirated. The dysphonia and stridor resolved immediately. Six weeks later, the patient underwent definitive surgical excision of the laryngocoele. CONCLUSION: Laryngopyocoele is a rare diagnosis. It can present as an acute airway emergency. We present the first reported case managed by ultrasound-guided aspiration, which averted the need for endotracheal intubation or tracheostomy.

Randomized trial of neomycin/dexamethasone spray vs drop preparation for the treatment of active chronic mucosal otitis media.

Active mucosal chronic otitis media (COM) is notoriously difficult to treat. A randomized, non-blind trial of a drop vs spray preparation of neomycin sulphate (3250 units/ml) and dexamethasone 0.1% (Otomize) has been performed. The spray was significantly better than drops (91% vs 44%) in the resolution of activity in simple perforations (P = 0.002 chi 2 test, with continuity correction). In ears with an open mastoid cavity, 68% of those on the spray preparation became inactive compared with 42% on drops, a difference which just failed to achieve statistical significance (P = 0.06). It is concluded that the spray delivery system is a significant improvement over drops for the treatment of active mucosal COM particularly in the absence of a mastoid cavity.