How we do it: 'tonsil swabs please' - an alternative use in open neck surgery.

BACKGROUND: Thyroid and parathyroid surgery often involves the use of heated instruments for dissection. Whilst these are beneficial, accidental thermal damage to the exposed skin edges can occur, resulting in an unsatisfactory cosmetic outcome. Tonsil swabs can be used in head and neck surgery intra-operatively to control bleeding. This paper describes an alternative use for them in protecting wound edges during the procedure. METHOD: Damp tonsil swabs are sutured onto the wound edges after the initial skin incision. They remain present for the duration of the surgery and are removed at the time of skin closure. RESULTS: The tonsil swabs provide protection and help avoid accidental injury to the skin. No complications with this technique have been experienced. CONCLUSION: This paper describes a simple, effective and practical technique for protecting the skin during neck procedures using resources readily available in a standard ENT operating theatre.

Does the EarPopper(®) device improve hearing outcomes in children with persistent otitis media with effusion? A randomised single-blinded controlled trial.

OBJECTIVE: To provide an independent evaluation of the efficacy and safety of the EarPopper(®) in improving hearing outcomes in children with otitis media with effusion (OME) and reducing the ventilation tube insertion rate. STUDY DESIGN: Randomised single-blinded controlled trial. SETTING: The Ear Nose and Throat Department of a district general hospital (Heatherwood and Wexham Park). PARTICIPANTS AND METHODS: Twenty-nine children aged between 4 and 11 years diagnosed with persistent OME lasting at least 3 months with an average hearing of 25 dBHL or worse in the better ear were randomised to a treatment or control group for 7 weeks using random computer-generated codes. Syndromic children, children with developmental delay, previous grommets and cleft palate were excluded. The audiologists were blinded at the final post-treatment audiogram. RESULTS: After the seven-week period, the mean improvement in air conduction across all frequencies was 10.9 dBHL in the treatment group (P < 0.001) and 3.6 dBHL in the control group (P = 0.201). At every frequency, the treatment group had larger improvements in air conduction, the largest being at 4 kHz where the mean air conduction in both ears improved by 14.8 dBHL. Compliance with the EarPopper(®) was over 90%, the only side-effect reported being discomfort in the ears immediately after use which resolved and did not affect compliance. The ventilation tube insertion rate was 53.3% in the treatment group and 78.6% in the control group. Median follow-up time for all patients is 47.7 months. CONCLUSION: Our study shows that the EarPopper(®) is a safe, effective treatment option for children with hearing loss from persistent OME, and it reduces the rate of ventilation tube insertion. More studies with larger sample sizes are required to support our findings.

Handling of radioactive seed localisation breast specimens in the histopathology laboratory: the Western Australian experience.

Radio-guided occult lesion localisation using iodine-125 seeds (ROLLIS) is a novel method of localisation for impalpable in situ and invasive carcinomas that has been the subject of a recent pilot study and pilot study extension in Western Australia. Robust protocols for radiation safety, specimen labelling, specimen tracking, seed retrieval and seed disposal were developed at two Western Australian laboratories to minimise the risk of seed loss. The processes are safe and effective with no significant radiation exposure to pathologists and with acquisition of all seeds intact and undamaged. The success can be attributed to developing specific seed retrieval techniques, suited to local preferences at each institution, with input from surgeons, radiologists and medical physics personnel. These techniques are now routine and will continue in the randomised control phase of the ROLLIS study.

Functional outcomes following endoscopic laser cricopharyngeal myotomy with mucosal repair.

Endoscopic laser cricopharyngeal myotomy is an effective treatment for cricopharyngeal dysfunction, but concern remains over the risk of serious complications following the procedure. Some authors have therefore considered endoscopic laser cricopharyngeal myotomy with mucosal repair; however, outcome data for the procedure is scanty. This study aims to identify functional outcomes in a series of patients following endoscopic laser cricopharyngeal myotomy with mucosal repair. Endoscopic laser cricopharyngeal myotomy with mucosal repair was performed on 38 subjects in two centres over a period of 33 months. Pre- and post-operative outcomes were evaluated in 32 subjects using the Sydney Swallow Questionnaire and Reflux Symptom Index. An improvement in swallowing scores was seen in 30 subjects (94%, p < 0.001). The Reflux Symptom Index improved 28 subjects (88%, p < 0.001). Mean procedure time was 58 min. One subject (2.6%) developed mediastinitis following surgery, and four experienced (12.5%) a recurrence of dysphagic symptoms. Endoscopic laser cricopharyngeal myotomy with mucosal repair is an effective treatment for cricopharyngeal dysfunction. The complication rate observed in this study was comparable or lower than previously reported studies into endoscopic laser cricopharyngeal myotomy without mucosal repair. Larger studies may be required to determine the additional benefit of mucosal repair over endoscopic laser cricopharyngeal myotomy alone.

Superglue ear: our experience and a review of the literature.

Cyanoacrylate glue (Superglue) has the ability to bond a variety of surfaces firmly within seconds of use. Its application into the external ear canal (EAC) is a challenging problem for clinicians. We present 3 case reports of patients who presented at our hospital with superglue in their EACs: 1 was accidental, 1 was iatrogenic, and 1 was intentional. To our knowledge, iatrogenic application of cyanoacrylate glue to the EAC has not been reported previously. We describe our management of these cases and review similar cases reported in the literature. These cases highlight the pressing need for changes in the size, shape and colour of the containers to make them more easily recognizable and distinctive.

Traumatic tympanic membrane perforation by a needlefish: case report.

OBJECTIVES: We report a unique case of traumatic tympanic membrane perforation caused by a needlefish beak. We describe the mechanism of injury, the clinical findings and the treatment. CASE REPORT: An 11-year-old boy presented with otorrhoea and hearing loss secondary to a traumatic tympanic membrane perforation by a needlefish. The perforation was repaired by performing a myringoplasty, with satisfactory post-operative audiological results. CONCLUSION: To our knowledge, this is the first reported case of its kind. It is recommended that careful examination of the middle-ear space should always be carried out prior to and during myringoplasty if there is a possibility of a foreign body.

The good funeral: toward an understanding of funeral participation and satisfaction.

This study posits a model of funeral satisfaction in which religiosity predicts general funeral attitudes, which predict levels and types of funeral participation, mediating the relationship between attitudes and satisfaction in a particular bereavement context. Over a thousand respondents rated their attitudes toward funerals in general and evaluated the most recent funeral they had actually attended. The resulting model indicated that religiosity and favorable attitudes, when enacted through participation and involvement, tend to predict funeral satisfaction, in combination with favorable comparisons, and when the deceased was close and the death unexpected or tragic. Evaluations of the funeral, in turn, independently influence a person's general attitudes about funerals. Theoretical and practical implications for understanding funerals and bereavement are explored.

Intraoperative, imaging and pathological features in spinal cord vasculitis.

The surgical intraoperative findings in spinal cord vasculitis have not been previously described. The imaging appearances can mimic intramedullary spinal cord tumours. We present a patient with spinal cord vasculitis and mixed intraoperative findings of spinal vascular lesion and intramedullary tumour. Based on the absence of a confirmatory intraoperative smear, vessel obliteration and tumour debulking was avoided, preventing a catastrophic surgical complication. The limited literature and management options are also reviewed.