Otolaryngological burden of disease in children with primary ciliary dyskinesia in Victoria, Australia.

OBJECTIVES: The aim of this study was to summarize the otolaryngological manifestations amongst children with primary ciliary dyskinesia (cwPCD) to improve diagnosis, investigations and management amongst otolaryngologists. METHODS: A retrospective review of primary ciliary dyskinesia (PCD) diagnoses at our institution over an 8-year period between January 2014 and October 2022 was conducted. Patient characteristics, diagnosis, otolaryngological symptomatology, treatment and outcomes were recorded. RESULTS: 24 patients were identified. Thirteen patients (54%) had documented conductive hearing loss on audiological evaluation; with 11 (85%) requiring hearing aids. Six patients (25%) underwent middle ear ventilation tube (MEVT) insertion with 67% experiencing post-MEVT otorrhoea. Twenty children (83%) reported chronic nasal discharge however only 3 (13%) reported nasal obstruction. Nine patients (38%) had symptoms consistent with sleep disordered breathing with 79% of them requiring operative management with adenotonsillectomy. CONCLUSION: Middle ear effusion is common amongst cwPCD and should be managed with conservative measures due to the significant burden of post-MEVT otorrhoea. Sinonasal symptoms rarely need surgical intervention. Many otolaryngological symptoms of PCD are often underreported, particularly sleep-disordered breathing. Paediatric PCD patients should be managed in a multidisciplinary team with routine and tailored therapies to manage all aspects of the condition.

Inner ear and retrocochlear pathology on magnetic resonance imaging for sudden and progressive asymmetrical sensorineural hearing loss.

BACKGROUND: In sudden and asymmetrical progressive sensorineural hearing loss (SNHL), magnetic resonance imaging (MRI) is required to evaluate retrocochlear pathology and, with recent advances in MRI techniques, inner ear pathology. Given the limited literature regarding inner ear pathology associated with SNHL, we aimed to assess the incidence of retrocochlear and inner ear pathology, and congenital malformation on MRI in sudden SNHL (SSNHL) and progressive SNHL. METHODS: A total of 987 acoustic neuroma (AN) protocol MRI internal acoustic meatus studies performed at our institution to investigate SNHL between January 2013 and December 2015 inclusive were identified. Following categorization for indication of SSNHL versus progressive asymmetrical SNHL, MRIs with retrocochlear or inner ear abnormality, congenital malformation or other otology-related abnormality were identified, and further data were collected for these patients including patient demographics, associated symptomatology, management and outcomes. RESULTS: In SSNHL, aetiological abnormality on MRI was identified for 6.9% patients with AN present on 4% overall. 3.2% of MRIs for progressive asymmetrical SNHL identified a causative lesion with 2.3% of scans overall diagnosing AN. The incidence of congenital inner ear malformation on MRI in the setting of SSNHL and progressive asymmetrical SNHL are 1.7% and 0.6%, respectively. CONCLUSION: This is the first retrospective study of inner ear MRI abnormalities in both SSNHL and progressive asymmetrical SNHL in Australia and one of the largest cohorts published in the literature to date. MRI must be performed in the setting of SNHL to ensure aforementioned and rarer causative lesions are identified.

Analysis of social media use among Australian and New Zealand otolaryngologists.

BACKGROUND: Social media's rapid worldwide growth has permeated surgical practice. To date, no study has evaluated social media use amongst Australian and New Zealand otolaryngologists. METHODS: Cross-sectional study of all members of the Australian and New Zealand Societies of Otolaryngology Head and Neck Surgery with comprehensive searches of websites and social media platforms (Facebook, Twitter, LinkedIn, ResearchGate and Instagram) was performed. RESULTS: A total of 498 otolaryngologists were identified with 81.7% working in Australia; 79.1% had some form of online presence - either professional website or activity on ≥1 social media platform and 53.0% of otolaryngologists had a professional website and mean number of social media profiles averaged 1.35 per surgeon. LinkedIn was the most widely used social media platform (51.6%). 38.8% of otolaryngologists had Facebook accounts with 11.9% of those 'public' accounts used for business purposes. Otolaryngologists with a research and authorship interest had the highest mean number of social media accounts (1.78) and were more likely to be associated with ResearchGate, LinkedIn and website ownership. Facial plastic surgeons averaged the second highest mean number of social media accounts per surgeon (1.71) and were most active on Facebook, Instagram and YouTube. There was a linear decline in the mean number of social media accounts per surgeon and rate of professional website ownership with increasing years in practice. CONCLUSION: Social media uptake amongst otolaryngologists appears consistent with colleagues in other surgical specialties. Otolaryngologists with fewer years in practice and specialty interests in facial plastic surgery and authorship and research are significantly more active on social media.

Review of epiglottitis in the post Haemophilus influenzae type-b vaccine era.

BACKGROUND: This study reviewed the demographics, presentation, management, complications and outcomes of acute epiglottitis post Haemophilus influenzae type-b vaccine introduction in Australia. METHODS: Retrospective review of acute epiglottitis at four Victorian tertiary centres from 2011 to 2016 was conducted. Patient characteristics, presentation, investigations, management, complications and outcomes were recorded. Subgroup analysis aiming to identify risk factors for patients requiring acute airway management was performed. RESULTS: Eighty-seven adult and six paediatric cases were identified. The most frequent clinical findings in adults were sore throat (88.5%), dysphagia (71.3%), odynophagia (57.5%), dysphonia (56.3%) and fever (55.2%); 75.9% required intensive care unit admission. Airway compromise requiring intubation occurred in 27.6%, with 12.5% of these patients undergoing emergency surgical airways. Stridor, hypoxia, shortness of breath, odynophagia and lymphadenopathy were statistically more frequent amongst cases requiring airway intervention (P < 0.05). Cultures revealed mixed results with no aetiological pattern. H. influenzae type-b was never cultured. Amongst paediatric cases, fever, tachycardia and stridor were frequently observed and all were admitted to intensive care unit. Two of six required intubation and one underwent surgical intervention. There were no deaths, but one patient suffered a hypoxic brain injury. CONCLUSION: Modern epiglottitis is not the disease previously encountered by clinicians. With changing demographics and varying organisms, management is adapting to reflect this. Complications are rare, and symptomatology at presentation aids earlier recognition of patients who may require airway protection.

A Novel Technique for Sutureless Proximal Aortic Endograft Revision in Type 1A Endoleak.

Management of type 1A endoleaks can be challenging. In the endovascular era, this condition is expected to become more frequent. Conventionally, surgical explant of the endograft remains the "last-resort" surgical treatment when all endovascular or other open options are exhausted. Endograft removal is a difficult and morbid procedure. An alternative technique is described that involves cinching the endograft after disengagement of the proximal fixation hooks. The endograft is redeployed within a prosthetic aortic replacement graft with an overlapping zone. This can reduce complications such as from additional anastomoses, graft bleeding, prolonged clamping, operative time, and associated comorbidities.

Bone wax extrusion through postauricular wounds: A case series.

Bone wax is an effective hemostatic agent that generally is considered safe. However, because it is nonabsorbable, significant complications can occur. We present the first two reported cases of delayed migration and extrusion of bone wax through postauricular wounds due to foreign body reaction and granuloma formation following mastoid surgery. We also present a literature review of complications associated with intraoperative bone wax use and discuss alternative hemostatic agents. Laryngoscope, 128:369-372, 2018.

Rare presentation of Wegener's granulomatosis in the pituitary gland: Case report and literature review.

INTRODUCTION: Wegener's granulomatosis (WG) is a systemic vasculitis that can affect a variety of organs including ear, nose and throat, lungs and kidneys. However WG is unusual in the pituitary and rare in the central nervous system. PRESENTATION OF CASE: A 56-year-old male with likely WG presented with polyuria and polydipsia despite six months of conservative medical management. MRI scanning revealed an enlarging heterogeneously enhancing pituitary gland. Following endoscopic transsphenoidal pituitary biopsy and debulking, final tissue pathology was diagnostic for WG in the pituitary gland. DISCUSSION: Diagnosis remains difficult but most patients present with central diabetes insipidus (CDI) as well as varying degrees of hypopituitarism on a background of disease activity in other organs. Clinical judgment needs to balance the need for invasive surgical tissue diagnosis with increasing immunosuppressive therapy. CONCLUSION: It is important to consider this rare complication of WG to ensure timely diagnosis and management.