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.

Ear presentation of Lyme borreliosis in a child.

OBJECTIVE: This case report aims to raise awareness amongst clinicians of ear presentation of cutaneous borrelia. CASE REPORT: We report a recent case of borrelia lymphocytoma cutis benigna in a child presenting with unilateral earlobe swelling, who was otherwise well. A review of the English language literature, including management of the disease, is also presented. CONCLUSION: This case highlights the fact that borrelia lymphocytoma should be included in the differential diagnosis of a persistent, unilateral, inflamed, swollen earlobe in an otherwise healthy child.

The impact of endonasal dacryocystorhinostomy (DCR), on patient health status as assessed by the Glasgow benefit inventory.

OBJECTIVE: To measure the effect of Endonasal DCR on the health status of patients, using a validated outcomes measure, the Glasgow Benefit Inventory. METHOD: Postal questionnaire with telephone follow up of patients undergoing Endonasal DCR in two institutions in Scotland. The same surgical technique is used in both centres. Patients were identified from prospectively collected data on consecutive patients undergoing this procedure. All adult patients, a minimum of twelve months post-intervention, were included. RESULTS: Ninety two of 123 patients (75%) completed the questionnaire, the mean age was 59 years and the sex ratio m:f was 1:1.8. The mean overall GBI for this intervention was + 32.7 (95% confidence intervals 27.8 - 37.6). The patients were grouped according to the indication for intervention: Obstruction of lacrimal system GBI + 32.7 (26.3-37.1), mucoecele + 40.1 (28.7-51.4), dacryocystitis + 19.4 (10.0-28.9). CONCLUSION: The GBI provides a measure of the effect of an ORL intervention on the health of a patient. Endonasal DCR scores highly when compared with a number of other rhinological procedures including rhinoplasty (GBI + 20), endoscopic sinus surgery (GBI + 23), and septal surgery (mean ranges from + 6 to + 24). Endonasal DCR is a successful intervention with demonstrable health benefits to the patient.

Satisfaction with cosmesis following nasal manipulation: do previous fractures matter?

OBJECTIVE: To determine if patients who have had multiple previous nasal fractures and who undergo manipulation of fractured nasal bones under general anaesthetic (MUA) are as likely to be satisfied with their post-operative nasal cosmesis as patients who have only sustained a single injury. DESIGN: Telephone survey. SETTING: District general hospital. PARTICIPANTS: Adult patients who had undergone MUA over the preceding three years. MAIN OUTCOME MEASURES: Patient satisfaction with nasal cosmesis and nasal airway and willingness to consider corrective surgery. RESULTS: One hundred and two patients were contacted. Overall patient satisfaction with cosmesis and nasal airway was 82 and 77 per cent, respectively, with 15 per cent willing to consider a procedure to improve their nasal cosmesis and 12 per cent willing to consider a procedure to improve nasal airway. Twenty-three (22.5 per cent) gave a history of one or more nasal bone fractures, either treated or untreated, prior to the most recently treated injury. Patient satisfaction with cosmesis in this group was 65 per cent, compared with 87 per cent satisfaction in the single injury group (p = 0.03). No statistically significant differences were demonstrated when comparing these groups for: satisfaction with nasal airway (70 vs 80 per cent, p = 0.46); willingness to consider a procedure to improve cosmesis (26 vs 11 per cent, p = 0.16); and willingness to consider a procedure to improve nasal airway (17 vs 10 per cent, p = 0.46). CONCLUSIONS: A history of multiple previous nasal fractures does appear to alter patient satisfaction with the cosmetic outcome of nasal manipulation. These patients should be informed that they have a decreased chance of attaining a cosmetically acceptable result.

The use of topical nasal anaesthesia before flexible nasendoscopy: a double-blind, randomized controlled trial comparing cophenylcaine with placebo.

The objective was to evaluate the necessity to use topical nasal anaesthesia before flexible nasendoscopy and to compare its use with placebo. The study was carried out using a double-blind randomized controlled trial, with three treatment arms, at the out-patient department at Raigmore Hospital, Inverness. The participants were 90 patients attending the otolaryngology out-patient department who required flexible nasendoscopy as part of their assessment. Each participant was randomized to one of three groups. Group 1 received cophenylcaine spray, group 2 received a placebo spray, and group 3 received no nasal preparation. Flexible nasendoscopy was carried out via a stated protocol and the patient's diagnosis and findings were discussed in the usual way. After the consultation, the patient filled in a questionnaire marking answers on a visual analogue scale. The main outcome measures were pain and overall unpleasantness of procedure. Patient anxiety and willingness to be examined again in the same way if necessary were also assessed. Ease of examination and quality of view were asked from the operator's perspective. The mean scores on a visual analogue scale showed the main outcome measures to be as follows. Pain score measured 1.7 for cophenylcaine, 2.1 for no spray and 2.2 for placebo. Overall unpleasantness scores were 2.0 for cophenylcaine, 1.9 for no spray and 2.4 for placebo. On a visual analogue scale of 0-10, none of these mean main outcome measures reached levels of significance. It was concluded that the use of cophenylcaine spray before flexible nasendoscopy does not give significant advantages over the use of no nasal preparation.

Metachronous bilateral submandibular gland metastases from carcinoma of the breast.

Metastases to the salivary glands from distant neoplasms are unusual, with most reported cases involving the parotid gland. Metastatic deposits in the submandibular gland are extremely rare with bilateral involvement not previously reported. We present the case of a patient with advanced breast carcinoma who has had metachronous involvement of both submandibular glands and review the literature on this subject.

A review of otolaryngology equipment provision in a peripheral clinic setting.

OBJECTIVE: To assess the adequacy of otolaryngology equipment provision in peripheral outpatient clinics. DESIGN: Prospective questionnaire study. SETTING: Five peripheral otolaryngology clinics in the Highlands of Scotland. (Thurso, Golspie, Dingwall, Fort William and Skye). SUBJECTS: All patients attending the above clinics over a six-month period. RESULTS: The questionnaire return rate was 70%. 30% of patients may have had improved care had the equipment provision been adequate. Nine percent of patients required to be reviewed elsewhere due to inadequate equipment. The annual cost of these reviews exceeds 15,000 Pounds. CONCLUSION: The provision of adequate clinic equipment would have medium to long term economic advantages and also has relevance in relation to clinical governance and potential medico-legal concerns. The results of this review are timely as a recent BAO-HNS document has confirmed the equipment provision we describe above as being at the minimal acceptable level.

Bipolar scissor tonsillectomy.

We describe a new technique for tonsillectomy using dual-function scissors that cut and bipolar coagulate at the same time. The technique shortens operating time and decreases intra-operative blood loss. Forty patients had their tonsillectomy performed using this technique. The mean operating time was 5.5 min (SD 2.1) and mean blood loss was 1.3 ml (SD 3.6). All patients were able to eat and drink on the same postoperative day and all were discharged the following morning. None of the patients had primary haemorrhages and two patients (5%) had minor secondary haemorrhages. We found bipolar scissor tonsillectomy to be a safe technique that shortens surgery and minimises blood loss without causing increased postoperative morbidity.

Focal myositis of the sternocleidomastoid muscle.

Focal myositis is an unusual inflammatory lesion of skeletal muscle. It usually affects the extremities, but can present rarely in the head and neck region. We present a case of an elderly woman with focal myositis of the sternocleidomastoid muscle and review of the previous literature on this subject.

The 9-kDa phosphoprotein of photosystem II. Generation and characterisation of Chlamydomonas mutants lacking PSII-H and a site-directed mutant lacking the phosphorylation site.

The chloroplast gene psbH encodes a 9-10 kDa thylakoid membrane protein (PSII-H) that is associated with photosystem II and is subject to light-dependent phosphorylation at a threonine residue located on the stromal side of the membrane. The function of PSII-H is not known, neither is it clear what regulatory role phosphorylation may play in the control of PSII activity. Using particle gun-mediated transformation, we have created chloroplast transformants of Chlamydomonas reinhardtii in which the synthesis of PSII-H is prevented by the disruption of psbH, or in which the phosphorylatable threonine is replaced by alanine through site-directed mutagenesis of the gene. The mutants lacking PSII-H have a photosystem II-deficient phenotype, with no detectable functioning PSII complex present in whole cells or isolated thylakoid membranes. In contrast, the alanine mutant (T3A) grows photoautotrophically, and PSII activity is comparable to wild-type cells as determined by various biochemical and biophysical assays.