Tonsillectomy and biopsy for asymptomatic asymmetric tonsillar enlargement: are we right?

OBJECTIVE: The aim of this study was to evaluate the incidence of malignancy in patients with clinically asymmetrical tonsils and who are otherwise asymptomatic. DESIGN: Retrospective review of our experience based on case note review, carried out in a district general hospital setting during a period of two years. MATERIAL AND METHODS: 142 patients who had undergone tonsillectomy and biosy were included in the study. Histological studies of all these patients obtained and correlated with the clinical findings. RESULTS: None of the patients with asymmetric enlargement of tonsils but are otherwise asymptomatic had shown histological evidence of malignancy. However all the 3 patients with associated suspicious symptoms in the presence of asymmetric tonsils were diagnosed as having tonsillar malignancy. CONCLUSION: Tonsillar asymmetry in the absence of other associated risk factors may not indicate malignancy and a period of watchful waiting is considered appropriate prior to any surgical intervention.

Accuracy of finger-tip palpated tracheostomy tube cuff pressure readings among otolaryngologists.

The tracheal mucosa is very a delicate structure, and pressure-ischaemia problems following the use of cuffed tracheostomy tubes are well documented. Iatrogenic tracheal stenosis is one of the consequences of mucosal ischaemia and is very difficult to treat. In this study the accuracy of finger-tip tested tracheostomy tube cuff inflation pressure, as judged by consultants and non-consultants, was assessed by comparison with manometric pressure readings. The estimated pressure readings from the consultant group were more accurate than those from the non-consultant group, but a high standard deviation and very big difference between low and high readings in both these groups showed the real extent of the problem. Participants who performed 10 or more tracheostomies a year obtained more accurate results. No definite correlation was observed between the readings and the experience of the participants in otolaryngology or the size of the tube used. The authors recommend that instrumental monitoring of cuff pressure be considered good practice among junior otolaryngologists.

Intractable paroxysmal sneezing.

Intractable paroxysmal sneezing is a rare disease primarily affecting teenage girls. We present the case of a 12-year-old girl who demonstrated the classical features of intractable paroxysmal sneezing of psychogenic origin. Most of the reported cases are psychogenic in origin, but a number of other conditions may cause intractable paraoxysmal sneeze. Apart from a detailed history, clinical examination and relevant investigations, topical nasal anaesthesia should be tried for control of symptoms--that will help to differentiate psychogenic sneezing from organic sneezing. A timely diagnosis can avoid unnecessary medical trials, parental anxiety and poor school performance, as most of the patients are very young.