An unusual cause of pre-auricular swelling.

OBJECTIVE: To present an interesting cause of pre-auricular swelling. CASE REPORT: We report the case of a 39-year-old woman who presented to the ENT department as an emergency with swelling in the left pre-auricular region. The patient had recently travelled to Central America, where the botfly is endemic. On examination, there was a raised, indurated area with a central orifice. A botfly larva was suspected. The larva was suffocated with paraffin paste, allowing removal without remnants being retained. CONCLUSION: Suffocation of botfly larvae is favoured to surgical removal, due to the possibility of larval remnants being retained and acting as a nidus for infection. The increasing frequency of exotic travel means doctors need to be more aware of tropical medicine.

A long term follow up of conchal flap meatoplasty in chronic otitis externa.

A long-standing diffuse chronic otitis externa can lead to itching. Resultant scratching may then lead to irreversible skin changes with canal stenosis by scar tissue. The poor ventilation and increased humidity gives rise to bacterial and fungal growths leading to breakdown of the skin defences and worsening itching. This vicious itching-scratch cycle or downward spiral often fails to respond to medical treatment. For these cases a simple conchal flap meatoplasty may improve ventilation of the external auditory canal and may lead to a self cleaning ear. We reviewed 84 patients who had undergone conchal flap meatoplasty in Calderdale and Huddersfield NHS Trust Hospitals from April 1993 to June 2002. A long-term follow up of conchal flap meatoplasty in chronic otitis externa showed no records of complications or further otitis in 93.2 per cent of cases. Thus surgical intervention plays an important role in the treatment of otitis externa not responding to treatment.

Improvement in hand-held CO2 laser safety.

A modification of the CO2 laser hand-piece is presented which utilizes a simple finger controlled mechanical shutter. This instrument safeguards against accidental direction of the laser beam.

Conchal flap meatoplasty.

A meatoplasty technique is described which has proved successful in the treatment of chronic otitis externa. The procedure opens the superficial meatus by eliminating the sharp rim at the junction of the conchal bowl and the posterior canal wall cartilage; thinning the skin and increasing the circumference of the external auditory orifice.

Necrotizing fasciitis of the neck.

Necrotizing fasciitis (N.F.) is a rare but serious infection of subcutaneous tissues and deep fascia with resulting skin gangrene and septicaemia. It is due to mixed anaerobic and aerobic organisms. It has been reported under a variety of synonyms. We describe two cases of necrotizing fasciitis of the neck probably secondary to chronic dental infection, one was diagnosed early and the other late with very different outcomes. We highlight the importance of early and aggressive surgical treatment to complement parenteral antibiotics covering both aerobic and anaerobic organisms.

Some observations on submucous diathermy.

Submucosal diathermy (SMD) of the inferior turbinates is widely used, although its effect histologically has not been well shown. We attempted to demonstrate the acute histological changes of SMD by performing it immediately prior to inferior turbinectomy. The results found help to explain the unpredictability of producing a clinical response.

The effect of Mucodyne on nasal clearance in healthy adults.

A randomized double-blind cross-over trial in healthy young adults compared the effect of S-carboxymethylcysteine (2.25 g per day for 7 days) against placebo on nasal mucociliary clearance. The clearance rate of a radio-labelled aqueous test spray was measured by gamma scintigraphy. Analysis of the data revealed no significant effect of the drug compared to placebo.

Swimming with a mastoid cavity: what are the risks?

The authors have found no studies and little guidance in the literature on the advisability of people swimming with a modified radical mastoid cavity. Two groups of such outpatients were therefore followed up at 2-monthly intervals for 6 months. One group of 56 patients swam (81% without ear protection) and the other group of 55 patients maintained their ears quite dry. Swimming did not increase the incidence of an infected mastoid cavity. The most important risk of swimming was vertigo which occurred in 5% of swimmers.

Exostoses of the internal auditory canal.

An incidental post-mortem finding is reported. Its clinical relevance is discussed. It is suggested that some EAC exostoses may have a similar origin and thus an association with IAC exostoses.

Acute blinding sinusitis.

Sinusitis may produce blindness, and deterioration in visual acuity is a strong indication for urgent admission and possible surgery.