A randomised controlled trial comparing Rapid Rhino Mannheim and Netcell series 5000 packs following routine nasal surgery.

OBJECTIVES: To determine whether there is a difference in discomfort between Netcell Series 5000 and Rapid Rhino Mannheim 8.0 cm (Cat. No. 800) packs used after routine nasal surgery, whilst in situ and during removal. This was tested in a single blind, randomised controlled trial at the ENT Department, Royal Devon & Exeter Hospital. PARTICIPANTS: Adults aged 16-65 undergoing nasal septal surgery and trimming of inferior turbinates. Patients were excluded if they were undergoing revision surgery, taking anticoagulants, or had a history of sino-nasal disease or trauma. Thirty nine entered and 32 completed the study. The intervention was a different nasal pack in each side of the nose, removed the morning after surgery. MAIN OUTCOMES MEASURES: Pain experienced by patients while packs are in situ and on removal as recorded on a standard unmarked 100 mm visual analogue scale. RESULTS: There was no difference in the pain scores whilst in situ. Rapid Rhino Mannheim was more painful on removal (difference = 10.6 mm, p < 0.001, Wilcoxon signed ranks test). CONCLUSIONS: Rapid Rhino Mannheim packs do not confer a benefit over Netcell Series 5000 packs after routine nasal surgery.

Metastatic renal cell carcinoma presenting as an aural polyp.

Renal cell carcinoma may metastasize to the head and neck region at different stages of its evolution. We present a case of an undiagnosed renal cell carcinoma presenting as an ear polyp, and discuss the difficulties of the diagnosis and the management of these tumours.

A cost-benefit analysis of the post-operative use of antibiotic ear drops following grommet insertion.

A prospective randomized controlled study was carried out to investigate the effect of prophylactic antibiotic ear drops used for five days after bilateral grommet insertion. The average improvement in the hearing threshold was significantly better in ears in which there was an effusion (16 dB) compared with no effusion (9 dB). The drops had no significant effect upon grommet function at three months measured by blockage rates, extrusion rates or improvement in pure tone audiometry whether or not there was an effusion. The drops were not therefore cost-effective.

Primary neuroblastoma of the facial nerve presenting as a recurrent facial paralysis.

A case is described of a primary neuroblastoma of the facial nerve in a 13-year-old boy presenting with a recurrent facial paralysis. This tumour was excised preserving the nerve and followed with post-operative radiotherapy. The pathology of the tumour is described and facial nerve tumours briefly discussed as a cause of facial palsy. There have been no other cases of a primary neuroblastoma of the facial nerve arising at this site reported in the last 20 years.

Blast injury of the ear: an overview and guide to management.

Blast injury is uncommon in many parts of the world but sporadic cases occur. The ear is particularly susceptible to damage and easily forgotten in patients with multiple injuries. The aim of this review article is to draw together the more important aspects of blast ear injury for those who are unfamiliar with it and to serve as a reminder of the problems to others. It covers the interactions of blast waves with the ear giving a summary of the mechanisms and types of injury. The management of blast-related injuries is discussed.

The laryngectomee and swimming.

Following laryngectomy patients are usually advised that swimming is no longer possible. Under supervised conditions and using a swimming aid, such as described, a laryngectomee may return to an activity previously considered unavailable, rehabilitation thus being more complete. However, for a laryngectomee to proceed a safe supervised environment is required, and the path to this goal is often long and arduous, but with persistent dedication the Laryngectomy Swimming Club may become a reality bringing rich reward.

Haemorrhage as a complication of inferior turbinectomy: a comparison of anterior and radical trimming.

A study was conducted to see whether the turbinectomy technique used influenced the incidence of haemorrhage. In a group of 214 patients who underwent bilateral turbinate surgery, haemorrhage occurred in 0.9% of those who had anterior turbinectomy and 5.8% who had radical turbinectomy (P < 0.05). It is concluded that confining excision to the anterior end of the inferior turbinate offers the advantage of a lower incidence of haemorrhage.

Blast injury of the auditory system: a review of the mechanisms and pathology.

Blast injury of the auditory system is uncommon and our knowledge incomplete. This article reviews the literature to date giving an account of the interactions of blast waves with the ear, the mechanisms of injury, the pathology, the clinical features, and an outline of management principles.

Two cases of lateral sinus thrombosis presenting with extracranial head and neck abscesses.

Two cases of lateral sinus thrombosis in fit adults with no previous otological history are presented. One case occurred in association with Bezold's abscess and followed mastoiditis which was masked by previous antibiotic treatment. The other case occurred in association with an occipitoparietal scalp abscess and there was no obvious preceding middle ear infection. The causative bacteria were Streptococcus milleri and a variant Streptococcus intermedius. Lateral sinus thrombosis is discussed.

A comparison of packing materials used in nasal surgery.

A prospective study was performed to compare Telfa, paraffin gauze, Merocel and BIPP used postoperatively following septal or turbinate surgery. Packs were assessed in terms of patient comfort, control of bleeding and ease of removal. There was little to choose between the packs while they were in situ and there was no significant difference in ease of removal. On removal the Telfa and paraffin gauze were associated with less discomfort and less bleeding than BIPP or Merocel (p < 0.05).

Primary cerebral lymphoma presenting with bilateral cerebellopontine angle lesions.

A case is described of a primary cerebral lymphoma which presented with bilateral cerebellopontine angle lesions. No similar case has been reported in the English language in the last 25 years. The literature is reviewed and discussed.

The latissimus dorsi flap in head and neck reconstructive surgery: a review of 121 procedures.

The results of a prospective study of 121 latissimus dorsi flaps performed during head and neck reconstructive surgery at the Royal Marsden Hospital are presented. Three-quarters of the flaps were pedicled and one-quarter were free. All the patients underwent surgery for malignant disease. The flap failure rate was 5%, other flap related complications occurred in 19% and the overall rate of complications was 26%. Previous radiotherapy, site of reconstruction, type of flap (free or pedicled) and age of the patient were not significant risk factors. Men were more likely to have a complication than women.

Metastatic seminoma of the sphenoid sinus.

Metastatic tumour of the sphenoid sinus from distant primary sites are rare. If sphenoid involvement from adjacent structures is excluded there have been 26 reported cases of metastatic sphenoid sinus tumours. Seminoma metastatizing to other paranasal sinuses has been reported but a careful literature search did not reveal this occurring previously in the sphenoid sinus.

Tracheo-oesophageal puncture: a review of problems and complications.

Tracheo-oesophageal puncture now has a well established role and in several units is now the principal means of speech rehabilitation following laryngectomy. Although not a difficult procedure, there are a number of problems and complications that may be encountered. With proper management these can usually be overcome and a useful voice achieved. This study looks at those problems in a series of 119 patients and discusses their management.

Squamous liver metastases from a carcinoma arising within a pleomorphic adenoma of the parotid gland.

A case of liver metastases from a squamous carcinoma arising within a pleomorphic adenoma is presented. The literature is reviewed and the clinical features, pathology and treatment of these tumours are discussed briefly.