Do wind and brass players snore less? A cross-sectional study of snoring and daytime fatigue in professional orchestral musicians.

OBJECTIVES: To determine whether playing a wind or brass musical instrument is associated with reduced snoring or daytime fatigue. DESIGN: Cross-sectional, controlled, anonymous, questionnaire-based observational study. SETTING: Rehearsal and performance halls. PARTICIPANTS: Three hundred and forty musicians from Scotland's five professional orchestras. MAIN OUTCOME MEASURES: Snore Outcomes Survey questionnaire and the Epworth Sleepiness Score. STATISTICAL METHOD: Hierarchical linear regression analysis. RESULTS: No significant difference was found between the snoring severity (Snore Outcomes Survey score) or daytime sleepiness (Epworth score) of wind/brass and other professional musicians. A regression model with snoring severity (Snore Outcomes Survey score) as the dependent variable and the three covariates of gender, age and body mass index as independent variables was significant [F(3, 206) = 28.77, P < 0.01, adjusted r(2) = 0.285]. Increasing age, body mass index and male gender were all significantly associated with lower Snore Outcomes Survey scores (i.e. worse snoring).The addition of instrument type did not significantly increase the fit of the model, and the regression coefficient for instrument type was not significant. There were similar results when the Epworth Sleepiness Score was used as the dependent variable. CONCLUSIONS: This study demonstrated no significant difference between the snoring severity or daytime sleepiness of brass/wind players and other professional orchestral musicians. This result may have been attributed to comparatively low levels of snoring/daytime sleepiness in the population studied. The findings contrast with previous studies examining the effects of singing and didgeridoo playing but concur with a recent similar study of orchestral musicians. A prospective interventional study would be required to determine whether playing a wind or brass instrument improves these variables in patients complaining of disruptive snoring.

Contact endoscopy of the larynx: a quantitative study.

Contact endoscopy is a technique of obtaining detailed magnified images of living epithelium, using a modified glass rod lens endoscope placed on the surface of the tissue. The technique has been extensively described in gynaecological, and more recently, laryngeal and nasal tissues. However, no quantitative studies of its diagnostic accuracy yet exist. A prospective partially blinded controlled study of eight cases with a variety of laryngeal pathologies is described. A single pathologist with no knowledge of the ultimate histological diagnoses successfully identified six of eight laryngeal pathologies on contact endoscopic findings, while the other two cases were identified to a degree of accuracy that was sufficient to positively identify the need for standard tissue biopsy. The advantages and disadvantages of the technique are described, along with suggestions for its role in clinical practice.

On which day is pain worst following adult tonsillectomy?

Anecdotal evidence from several ENT departments suggests that pain following tonsillectomy is worst on the second and/or third days after surgery. This study tests this hypothesis. A pilot study with 19 subjects suggested this theory might well be true. A fuller study was then carried out on 91 subjects with standardised surgical and anaesthetic techniques, and standardised analgesia for five days postoperatively. Pain on the second and third postoperative days was compared with that eight hours after the operation and on the first, fourth and fifth postoperative days. No statistically significant difference was found. There is increasing pressure for early discharge from hospital after surgery. If pain following tonsillectomy is not going to become worse at home, this will tend to make early discharge more acceptable to patients.

Stridor in patients with HIV infection.

The immunodeficiency which results from HIV infection is associated with a range of opportunistic infections and tumors which may present with the symptoms of upper airways disease. This paper presents three cases of stridor from different causes in patients with HIV infection, all of whom recovered following treatment. The management of this problem requires consideration of the likely aetiology which, in those with advanced immunodeficiency, includes bacterial and fungal laryngitis and epiglottitis as well as rapidly growing laryngeal tumours. Recommendations for the treatment of those with HIV infection who present with severe or rapid-onset stridor should include a combination of aggressive airway intervention and broad-spectrum antibacterial and antifungal agents. Laryngeal biopsy for histology and culture is particularly important for those patients who fail to respond to the aforementioned treatment.

Lateral cutaneous nerve of the thigh blockade as primary anaesthesia for harvesting skin grafts.

The lateral cutaneous nerve of the thigh (LCNT) supplies a large area of skin in an ideal site for harvesting a split skin graft. LCNT block was used as primary local anaesthesia for harvesting split skin grafts in 23 patients with a variety of injuries. Their ages ranged from 26 to 99 years. The mean age was 69 years. The onset of full anaesthesia took between 15 and 20 min. The area anaesthetised ranged from 250 cm2 to 1020 cm2 with a mean of 569 cm2. There were 17 successful blocks and 6 failures. Most of the 6 failures occurred during the early phase of the study. We have found that, with experience, LCNT block is a safe, simple and reliable method for achieving adequate anaesthesia for harvesting split skin graft from the thigh and that it provided excellent postoperative analgesia.

The management of acute sigmoid volvulus in Nottingham.

Forty previously undiagnosed cases of acute sigmoid volvulus presenting over five years in Nottingham are retrospectively reviewed. The average age was 71.6 years with an even sex ratio. Fifteen (38%) patients lived in nursing homes or institutions. At presentation, all had clinical features of large bowel obstruction, confirmed on plain abdominal X-ray. Sigmoidoscopy and rectal tube decompression was successful in 23 cases. The remaining 17 patients were treated surgically, within 24 hours, at which time the sigmoid was sutured to the abdominal wall (2 cases), resected and brought out as a colostomy (10 cases) or resected and primarily anastomosed (5 cases). Whilst in hospital, of those treated conservatively five died, and three from those treated surgically, four from those in which a colostomy was formed died and three from those in which a primary anastomosis was fashioned died. Of those that survived 11 from the conservative group had at least one recurrence, but none recurred following surgery. In conclusion, acute sigmoid volvulus affects an old and infirm population and carries a poor prognosis. Conservative management is initially preferable, but if emergency surgery is necessary a colostomy rather than primary anastomosis is indicated.