A retrospective review and multi-specialty, evidence-based guideline for the management of necrotising otitis externa.

BACKGROUND: Necrotising otitis externa is a progressive infection of the external auditory canal which extends to affect the temporal bone and adjacent structures. Progression of the disease process can result in serious sequelae, including cranial nerve palsies and death. There is currently no formal published treatment guideline. OBJECTIVE: This study aimed to integrate current evidence and data from our own retrospective case series in order to develop a guideline to optimise necrotising otitis externa patient management. METHODS: A retrospective review of necrotising otitis externa cases within NHS Lothian, Scotland, between 2013 and 2018, was performed, along with a PubMed review. RESULTS: Prevalent presenting signs, symptoms and patient demographic data were established. Furthermore, features of cases associated with adverse outcomes were defined. A key feature of the guideline is defining at-risk patients with initial intensive treatment. Investigations and outcomes are assessed and treatment adjusted appropriately. CONCLUSION: This multi-departmental approach has facilitated the development of a succinct, systematic guideline for the management of necrotising otitis externa. Initial patient outcomes appear promising.

On the minimum requirements for otolaryngology clinics in National Health Service hospitals.

OBJECTIVE: This paper, a report by the Clinical Governance and Audit Committee of the Scottish Otolaryngological Society, presents a consensus view of the minimal requirements for ENT clinics in National Health Service hospitals. RESULTS AND CONCLUSION: The provision of adequate equipment and staff has gained increasing importance as the vast majority of ENT procedures can be safely performed in the out-patient or office setting.

Prospective, blinded study of nasal injuries: comparison of doctor and nurse assessment.

OBJECTIVES: This study aimed to compare an experienced ENT treatment room nurse's ability to assess nasal injuries with that of junior doctors. DESIGN: One hundred consecutive patients with nasal injuries were assessed prospectively in two phases, followed by a telephone survey. MAIN OUTCOME MEASURES: Comparison of nasal injury assessment, advice, and outcomes regarding cosmesis, airway obstruction and patient satisfaction. RESULTS: In the first phase, there was almost perfect agreement between doctor and nurse assessments regarding the management of nasal fractures (p < 0.0001). There was no deterioration in outcomes in the nurse assessment only patient group with regards to cosmesis and airway obstruction. Ninety-four per cent of patients were satisfied with nurse-only assessment. CONCLUSIONS: Our study showed that an experienced treatment room nurse was as effective as experienced junior doctors in assessing and advising patients with nasal injuries. Following this study, the nurse involved began to independently assess patients with nasal injuries attending the unit.

Nasal bacterial carriage in adult epistaxis: is neomycin the answer?

INTRODUCTION: After treatment of epistaxis, patients are routinely supplied with an intranasal bactericidal cream containing neomycin. Neomycin cream is effective in preventing recurrent paediatric epistaxis. This study aimed to assess whether there is an increased rate of nasal bacterial infections in adult epistaxis patients. METHODS: Between October 2004 and April 2005, nasal swabs were taken from adult patients presenting with epistaxis, and from a control group comprising elective ENT patients. RESULTS: There were 23 controls and 26 epistaxis patients. Staphylococcus aureus was grown in 21 per cent and 23 per cent, respectively. There was no significant difference in bacterial carriage rates between the epistaxis and control groups. CONCLUSIONS: The epistaxis and control groups demonstrated the same bacterial species and the same proportion of bacterial carriage. Although the majority of bacterial species encountered were sensitive to neomycin, a significant proportion was not. These results do not support the routine use of neomycin in the prevention of recurrent adult epistaxis.

Identification of the accessory nerve by its relationship to the great auricular nerve.

OBJECTIVES: To describe the use of the great auricular nerve as a 'road map' for locating the accessory nerve in the anterior and posterior triangle, in comparison with other methods described in the literature. DESIGN: A review of the literature using Medline and Embase searches was performed. Illustrative photographs were taken from consenting, elective patients. RESULTS: Various methods have been described, using different anatomical landmarks. We describe a new method, based on the fact that the great auricular nerve runs, with relation to the edges of the sternocleidomastoid muscle, 1 cm superior to the accessory nerve anteriorly and 1 cm inferior posteriorly. CONCLUSIONS: This is a reliable and safe method, used by the senior authors in their extensive work as head and neck and skull base surgeons. It allows the accessory nerve to be located in both the anterior and posterior triangle. This avoids the inherent dangers of following the nerve's tortuous course through the sternocleidomastoid.