A rare case of foreign body impaction requiring oesophagotomy.

We report a rare case of ingestion of a large stone in a male patient with a known psychiatric disorder. Failure of endoscopic removal necessitated retrieval of the impacted stone by an open oesophagotomy. This case highlights an important yet unusual presentation and management of an oesophageal foreign body.

Bacterial colonization of laryngectomy stomas.

Infections with organisms resistant to conventional antibiotics are of increasing concern. This observational study investigates the bacterial colonization of the peristomal area of laryngectomy patients. Thirty-two consecutive patients who had previously undergone laryngectomy were recruited from the Head and Neck Clinic of a teaching hospital. Swabs were taken from the laryngectomy stoma site, the mouth and both nasal cavities. Microbiological culture and isolation were performed following standard procedures. Despite no clinical sign of infection, 27 patients were found to be carriers of one or more organism (84.4 per cent). Staphylococcus aureus was detected in the peristomal area of 15 patients (46.9 per cent). Methicillin-resistant Staphylococcus aureus (MRSA) was isolated in seven (21.9 per cent) cases. In this series the authors found a high incidence of colonization with potentially pathogenic bacteria in laryngectomy stomas with no clinical signs of infection. In a significant number of patients, Gram positive organisms were identified that could potentially cause cellulitis or wound infections.

Paediatric cochlear implant durability: the Nottingham experience.

OBJECTIVE: To determine durability of cochlear implant devices in a large paediatric cohort. DESIGN: Retrospective review of database records of children consecutively implanted between 1989 and March 2002. METHODS: The records of 363 children were studied. The review examined cases requiring explantation of the implant device for device failure with or without reimplantation. RESULTS: 15 failures were identified. The failure rates based on failures per number of implanted devices as well as cumulative user experience were 4.0% and 0.8% respectively. CONCLUSIONS: As implant programmes grow, so will the number of children requiring device explantation and reimplantation. This will have implications on implant programme development and resource allocation.

The place of endoscopic sinus surgery in the treatment of paranasal sinus mucocoeles.

Mucocoeles of the paranasal sinuses often enlarge slowly resulting in local bone erosion with subsequent extension into the adjacent orbit or intracranial space. We have reviewed the management of 59 patients with 68 mucocoeles. The variety of presentations is examined and discussed. Although diplopia has previously been stated as a very common finding we have found this not to be the case and believe that it may be that previous reports originate from ophthalmology centres. Forty-four patients underwent endoscopic surgical management of their mucocoeles, nine had a combined external and endoscopic procedure and 14 patients had an external approach. One patient needed no surgery. The mean follow-up period was 6 years 3 months. There was the lowest number of recurrences in the endoscopic surgical group. We emphasize the importance of long-term follow-up.

Reduction of nasal fractures under local anaesthesia: an acceptable practice?

Nasal fractures are among the most common bony injuries and are among the most frequent reasons for referral to Otorhinolaryngology departments resulting in significant pressure on clinical resources. We present our experience of a Nasal Fracture Clinic dedicated to the assessment of nasal injuries. A prospective study has been undertaken using questionnaires regarding patient satisfaction and acceptability of manipulation under a local anaesthetic (LA). During our three-month study period 91 new patients with nasal injuries were seen; 43 patients were diagnosed to have a displaced nasal fracture requiring reduction. Reduction of the nasal fracture under LA was performed in 37 patients. We found that manipulation under LA was preferred by 94% of patients over the age of 14 years. We achieved a high patient satisfaction rate (80% after three months). The discomfort associated with reduction under LA did not exceed that of a minor dental procedure. No significant complications were encountered during the study period. We conclude that reduction of nasal fractures under LA is a safe and attractive alternative to reduction under a general anaesthetic (GA) and frees-up valuable clinical resources.

Open water scuba diving accidents at Leicester: five years' experience.

OBJECTIVES: The aim of this study was to determine the incidence, type, outcome, and possible risk factors of diving accidents in each year of a five year period presenting from one dive centre to a large teaching hospital accident and emergency (A&E) department. METHODS: All patients included in this study presented to the A&E department at a local teaching hospital in close proximity to the largest inland diving centre in the UK. Our main outcome measures were: presenting symptoms, administration of recompression treatment, mortality, and postmortem examination report where applicable. RESULTS: Overall, 25 patients experienced a serious open water diving accident at the centre between 1992 and 1996 inclusive. The percentage of survivors (n = 18) with symptoms of decompression sickness receiving recompression treatment was 52%. All surviving patients received medical treatment for at least 24 hours before discharge. The median depth of diving accidents was 24 metres (m) (range 7-36 m). During the study period, 1992-96, the number of accidents increased from one to 10 and the incidence of diving accidents increased from four per 100,000 to 15.4 per 100,000. Over the same time period the number of deaths increased threefold. CONCLUSIONS: The aetiology of the increase in the incidence of accidents is multifactorial. Important risk factors were thought to be: rapid ascent (in 48% of patients), cold water, poor visibility, the number of dives per diver, and the experience of the diver. It is concluded that there needs to be an increased awareness of the management of diving injuries in an A&E department in close proximity to an inland diving centre.

Idiopathic diffuse erosion of the skull base presenting as cerebrospinal fluid rhinorrhoea.

We present an unusual case of generalized erosion of the skull base. We have not found a similar case reported in the world literature. The presenting symptom was spontaneous cerebrospinal fluid (CSF) rhinorrhoea which arose from a bony defect associated with herniation of the right temporal lobe into the sphenoid sinus. We discuss the management of such a case including imaging of the skull base and the endoscopic repair of the bony defect.