Transtemporal approach to otogenic brain abscesses.

The standard current treatment of an otogenic brain abscess is drainage via neurosurgical burr hole or complete excision, followed by an otological procedure to eradicate the primary pathology ­ often at a later date. We describe the drainage of otogenic brain abscess via a transtemporal approach. We present a retrospective study of six cases, five children and one adult. All the children had acute middle ear disease while the adult patient had a petrous apex cholesteatoma. All cases had an otogenic intracranial abscess either in the posterior cranial fossa or in both posterior and middle cranial fossae. Diagnosis was confirmed by computed axial tomography (CT) scan. All the patients were treated by mastoidectomy and needle aspiration to drain the abscesses. In all cases the brain abscess and the ear pathology were successfully treated by a single stage transmastoid approach. The five paediatric patients had an extended cortical mastoidectomy approach to both intracranial pathology and ear disease except one patient who required a burr hole to drain a posteriorly located subdural posterior fossa abscess. The adult patient underwent petrosectomy, followed by transtemporal abscess drainage. There was postoperative pus recollection in one patient who required further aspiration. We conclude that transtemporal drainage of an otogenic brain abscess can successfully treat otological and intracranial pathology in a single operation. It has a low complication rate and avoids the need for a craniotomy or subsequent operations.

Methods of hearing assessment in children.

Hearing problems can have a significant impact on a child's language and general development, and therefore early detection is important. Doctors dealing with children need to understand the various types of hearing assessment and their limitations.

New approach to the endoscopic repair of a CSF leak originating from the lateral recess of the sphenoid sinus.

Difficult access can make identification of a cerebrospinal fluid leak from the lateral wall of the sphenoid sinus very difficult, especially in a well-pneumatized sinus. Access to the sphenoid sinus has become easier with the advancement of minimally invasive endoscopic technology. In this article we describe our approach to a cerebrospinal fluid leak originating from this location, which has not been described previously in the literature.

Consent for mastoidectomy: a patient's perspective.

OBJECTIVES: The purpose of this study is to identify the difference between patients perspectives regarding the given information during the consenting procedure of mastoidectomy and the type of the provided information by the medical practitioners. This subject is becoming increasingly important because of the increase in the medico-legal litigation due to inadequate consenting process. METHODS: Nineteen patients who had undergone mastoid surgery were asked to identify which risks of mastoid surgery they felt were important to be informed of prior to surgery. This was compared to 20 ENT consultants' answers on which risks they routinely discuss with patients preoperatively. RESULTS: Our results show the 'average' patient would expect to be consented for all of the risks we asked about except for keloid scarring and altered taste, compared with the 'average' consultant who would discuss all risks routinely except for bleeding, intracranial complications and keloid scarring. The most obvious difference between doctor patient opinions is the topic of intracranial problems arising from surgery, 84.2% of patients would want to be warned about this but only 20% of surgeons routinely mention it (P-value < 0.001). CONCLUSION: The main reasons for consultants omitting discussion of intracranial complications were their rarity and patients potentially finding it distressing. However, recent court rulings indicate that these reasons are invalid and not giving comprehensive consent may be indefensible.

The use of silastic nasal splints in the treatment of chronic epistaxis and nasal septal ulceration.

Some cases of epistaxis are chronic and resistant to treatment. We describe a novel method of treating persistent epistaxis with Silastic splints. This procedure is simple to perform and reverse, and it is much better tolerated than is total obstruction of the nostrils (Young's procedure). In addition, the presence of the splints reduces the likelihood of digital trauma, which can prevent healing. We describe the case of a 43-year-old man with a 5-year history of persistent epistaxis who was successfully treated with this procedure.

Granulocytic sarcoma of the nasal cavity.

Granulocytic sarcoma (GS) is a rare localised tumour of malignant myeloid precursor cells occurring at an extramedullary site. It is usually associated with a myeloproliferative disorder but may be seen preceding the onset of leukemia. Extracranial GS may occur virtually anywhere in the body and may be easily confused with large cell and lymphoblastic lymphoma. This paper reports an unusual case of primary GS of the nasal cavity and paranasal sinuses, which presented as a nasal obstruction. Multidrug combination chemotherapies and bone marrow transplantation were performed. Awareness of the potential location of GS in the nasal cavity and paranasal sinuses should contribute to better define the prognostic significance of this uncommon entity.