More than 10 years registration of continuing medical education as part of quality control by the Netherlands Society for Oto-Rhino-Laryngology and Cervico-Facial Surgery.

After more than 10 years registration, 93% of ENT specialists in The Netherlands fulfil the requirements for continuing medical education in spite of the fact that sanctions (no re-registration) have not been implemented to date. Improvements have been made over the years. Information about how to set up a comparable system was supplied to 10 other scientific societies. A recurrent point for discussion is whether or not to award points for presentations, papers and (co)publications. On the one hand, it seems reasonable to reward the effort but, on the other hand, it creates practical problems. As a matter of fact, all members who give papers and write articles appear to attend more than enough postgraduate education. The process of accurate registration of continuing medical education, including accreditation and certification, is time-consuming. Moreover, it requires intensive and essential supervision by an experienced colleague who has a thorough knowledge of the specialist field.

[An eye on the vocal cords: family practitioner and hoarseness]. / Met het oog op de stembanden; huisarts en heesheid.

In four patients with hoarseness, men aged 53 and 67 years, and women aged 8 and 37 years, indirect laryngoscopy revealed, respectively, a squamous cell carcinoma of the vocal cord, recurrent nerve paralysis due to pulmonary carcinoma, irritative noduli due to forced use of the voice, and psychic stress as the cause. In a patient with existing hoarseness over a period of 3 to 6 weeks, the vocal cords will have to be examined with indirect laryngoscopy. Where the general practitioner is not equipped to handle this procedure, he can make a referral to an ear, nose and throat specialist. It would, however, be to the benefit of the patient and the general practitioner if the latter were to master the technique of indirect laryngoscopy. This would enable the patient to be treated without further delay, and it might also make selective referral possible.

[No reason to set an age limit on tympanic membrane closure in children]. / Geen aanleiding een leeftijdsgrens te stellen voor trommelvliessluiting bij kinderen.

The results of 819 tympanic membrane reconstructions performed by the author between 1974 and 1987 were reviewed. The mean follow up period was 5.6 years (range 2 to 10 years). An attempt was made to answer the question whether it is justified to set an age limit for performance of eardrum reconstructions in children. Of the 819 reconstructions 304 were done between the age of 4 and 16. The review shows that if a strict preoperative procedure is followed, there is no significant difference in closure rate between children (91%) and adults (90%). The grafting material did not influence the closure rate.

Nasolabial cyst: diagnosis mainly based on topography?

The nasolabial cyst is described in three patients and literature is shortly reviewed. The condition manifests itself by a smooth, fluctuating swelling in the nasolabial fold next to the ala of the nose. This clinical manifestation represents the most important criterion for diagnosis. Histopathology and cytologic findings are of minor importance for diagnostic purposes. Etiology is still uncertain. According to the most accepted theory the lesion has to be classified among the fissural cysts, but histopathologic findings may vary and do not give support to any of the theories of etiology. Computertomography is better than conventional roentgenography to demonstrate the extension of the lesion into surrounding structures. Echography can give important preoperative information. Nomenclature related to this cystic lesion is not uniform. Nasolabial cyst is the most adequate term, as it is describing the lesion only topographically and is not referring to controversial etiologic theories or to variable histopathology. Therapy consists of surgical removal using an intraoral approach and prognosis is excellent.