Could the presence of a Carhart notch predict the presence of glue at myringotomy?

The Carhart notch is a dip in the bone conduction at 2000 Hz without a corresponding dip in the air conduction. The main objective of this study was to establish how reliable is the presence of the Carhart notch in a preoperative audiogram in predicting the presence of glue at myringotomy. A prospective study has been carried out in 50 children presenting with glue ear to find out the association between the Carhart notch and the presence of glue at myringotomy. Children were seen before the operation and an audiogram and tympanogram were carried out. Myringotomy was carried out in 95 ears and the presence or absence of glue was recorded. The significance of the air-bone gap and the type of tympanogram in predicting a middle ear effusion were also examined. The audiograms of 37 ears showed a Carhart notch; of these, 36 ears were noted to have glue ear. The correlation between the presence of a Carhart notch in the preoperative audiogram and the presence of glue at myringotomy was found to be significant (P < 0.001) (chi-square test). Using the decision rule that the presence of a Carhart notch predicts the presence of glue, the following operating characteristics were determined: correct, 83 ears (87.4%); false positive, one ear (1.1%); false negative, 11 ears (11.6%). The presence of a Carhart notch was found to be a strong predictor of the presence of glue at myringotomy.

Use of hearing aids in the management of children with cleft palate.

OBJECTIVE: The incidence of otitis media with effusion in children with cleft palate is high. There are numerous reports looking at early insertion of ventilation tubes (VT) with associated complications. We believe that this is the first paper that discusses the use of hearing aids (HA) as the first line of management. METHODS: Children with cleft palate are managed in a special multidisciplinary clinic in our hospital. Detailed records of these children are maintained. We studied the otological management of 70 children with repaired cleft palate. RESULTS: 12 of the 70 (17.1%) had VT inserted, 17 (24.3%) were provided with HA, 14 (20%) had both grommets and HA and 27 (38.6%) had neither. Of the 31 (44.3%) children who had HA, 16 (51.6%) had good compliance with the HA. The hearing, speech and language developments in these children have been good. Twelve of the 70 patients (17.1%) have had one or more otological complications. These were significantly higher in children treated with VT. CONCLUSION: We have successfully treated 62.9% of our patients with non-surgical intervention, and show a low incidence of long term complications.

Acute angle closure glaucoma precipitated by intranasal application of cocaine.

We describe a patient who developed acute angle-closure glaucoma following the application of topical intranasal cocaine. A 46-year-old woman underwent an elective antral washout under general anaesthesia and with local application of 25 per cent cocaine paste to the nasal mucosa. Twenty-four hours post-operatively the patient developed sudden painful blindness which was found to be due to acute glaucoma. Cocaine with its indirect sympathomimetic activity causes mydriasis, that can precipitate acute angle-closure glaucoma in predisposed individuals with a shallow anterior chamber. Although the incidence is rare, otolaryngologists need to be aware of this potential complication.

Hydralazine-induced lupus and vocal fold paralysis.

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder that can affect the upper airway. Hydralazine has been known to cause a lupus-like syndrome that can produce the clinical manifestations of SLE. We discuss a case of hydralazine-induced lupus, presenting with acute laryngeal oedema and right vocal fold paralysis. Cessation of hydralazine therapy resulted in reversal of paralysis.

Hearing aids and glue ear.

This study was designed to determine the acceptance and effectiveness of a hearing aid in the management of children with persistent hearing loss due to glue ear (otitis media with effusion [OME]). Forty-eight children with OME, in whom the main symptom was deafness, were treated with a hearing aid instead of surgery and reviewed at 3-monthly intervals over 6-12 months. Seventy-one per cent reported unequivocal satisfaction with the aid. Sixty-five per cent used the aid continuously throughout the day whilst 35% used it only at specific times of need. Ninety-eight per cent noticed a definite improvement in their hearing whilst using the aid and this was confirmed audiometrically in 100%. Disability was considered in terms of speech development and educational achievement. In 66% there had been a subjective decline in these parameters prior to aid prescription. In all but one child significant improvement was made sufficient to alleviate parental and teachers' concern. No children reported significant symptoms due to OME other than deafness and there were no complications of hearing aid usage. At follow-up, however, 13% of children continued to use a hearing aid in an ear in which the OME had resolved. This study has shown that in this preselected group of children with persistent OME and the predominant symptom of deafness, a hearing aid was an effective treatment for their deafness with high acceptance and compliance.

A double-blind, randomized, prospective trial of a topical antiseptic versus a topical antibiotic in the treatment of otorrhoea.

The clinical efficacy was assessed of a topical antiseptic (aluminium acetate) and a topical antibiotic (gentamicin sulphate) for the initial treatment of otorrhoea. Evidence of resistant organisms developing to either treatments after 9 and 21 days was also examined. 139 affected ears were entered into the trial and of these, 102 (74%) completed the study. Improvement in the otorrhoea occurred in 68% of ears treated with gentamicin and 67% of ears treated with aluminium acetate, with no significant difference between the two treatments. No resistant organisms to aluminium acetate were encountered. Twelve gentamicin-treated ears had gentamicin-resistant organisms at presentation and one patient developed a gentamicin-resistant Pseudomonas during treatment. We therefore recommend a topical antiseptic such as aluminium acetate rather than a topical antibiotic in the initial treatment of otorrhoea on the grounds of cost, avoidance of resistance and toxicity.

Evaluation of recent experience in hypoglossal-facial nerve anastomosis in the treatment of facial palsy.

This evaluation of recent experience of hypoglossal-facial nerve anastomosis in ten patients who had undergone acoustic neuroma resection, indicates that this procedure may have a role to play in the treatment of this disfiguring condition. Facial symmetry at rest is satisfactory in the majority of patients, who suffered little long term deficit from the loss of their hypoglossal nerve. This procedure is ideally suited to otolaryngological practice.

Fat graft myringoplasty--a prospective trial.

A prospective trial to determine the success rate of the fat graft myringoplasty technique is reported. A success rate of 76% overall was attained at review 1 year postoperatively with increased success for smaller perforations of the tympanic membrane.

ENT teaching.

All medical schools include undergraduate ENT teaching, but the time allocated is short and the acquisition of practical skills may suffer. Efficiency is essential, particularly with regard to those destined for general practice, where 10-30% of the workload concerns the upper respiratory tract. The students at the Leeds Medical School, during 1 academic year, were surveyed by questionnaire on various aspects of their ENT course. Criticisms and suggestions for improvement were also invited. The results suggested the lecture course should not change but the time spent in operating theatres could be reduced in favour of more time in the outpatient clinics with a greater emphasis on practical skills. This discussion was then extended to consider what an ENT course should include and whether it could be integrated, in some way, with postgraduate education.

Pharyngeal diverticula: is a positive family history unusual or of consequence?

The aetiology of pharyngeal diverticula is unclear. There are only a few case reports of pharyngeal pouches occurring in families in the literature and the importance of inheritance has been relegated to 'other proposed aetiological factors' in a recent paper. We studied the incidence of a family history in all patients diagnosed as having pharyngeal pouches between 1980 and 1985 in the Leeds/Bradford area. Of 32 people questioned, 7 had died leaving no relative to provide the information. Five patients (20%) recorded a positive family history and 20 patients (80%) a negative history. This finding is of relevance to the controversy surrounding cricopharyngeal myotomy in combination with pouch excision. If these patients have a congenitally weak posterior pharyngeal wall then they may have a greater risk of recurrence without a simultaneous myotomy.

Efficacy of medical treatment as an adjunct to surgery in the treatment of secretory otitis media.

In a pilot controlled randomised trial of 38 children who had bilateral secretory otitis media, with effusion demonstrated at operation, we compared the efficacy of a six-week course of an oral decongestant--antihistamine combination and a mucolytic preparation with a control group in preventing the presence of middle-ear effusion six weeks after myringotomy and adenoidectomy. The mucolytic preparation decreased the presence of middle-ear effusion when compared to the decongestant-antihistamine combination and the control group (p = 0.06).

Day case surgery in otolaryngology: a 10-year analysis.

This paper analyses the ENT day case surgery performed over the period May 1974 to May 1984 in Cardiff. The patients undergoing such surgery, the types of surgery, forms of anaesthesia, travelling considerations, seasonal variation and admission rate are examined. The problems of list organization, patient selection and attendance are examined in detail in a 12-month period from May 1981 to May 1982.

The role of radiography in the management of nasal fractures.

The role of radiographs in the management of nasal fractures is assessed. The injury is common and the total cost of radiographs significant. A retrospective study concluded that radiographs were not definitive in the management of nasal fractures. This prompted a prospective study, in which 54 patients were assessed clinically, radiologically and under anaesthesia. At each stage they were grouped into treatment and pathological categories and the contribution of each type of assessment studied. Radiographs were not found to be useful in the routine management of nasal fractures.