Bone anchored hearing aids: a second fixture reduces auditory deprivation in Cambridge.

Bone anchored hearing aids are well established for canal atresia, otosclerosis and chronic suppurative otitis media. Refinements in technique to maximise gain while keeping the complications to a minimum are desirable. This study was taken up in order to explore the potential advantage of a second or spare fixture placed at the time of primary surgery. A group of patients who underwent BAHA insertion at The Emmeline Centre for Cochlear Implants and Bone Anchored Hearing Aids, Addenbrookes hospital, Cambridge, UK with the placement of a spare fixture between 1999 and 2002 were compared to those patients with one fixture BAHA undertaken from 1991. Main outcome measures were complications encountered and duration of disability, (i.e. loss of hearing while waiting for new fixture placement). Both groups had similar incidence of complications, but the group with two fixtures suffered a shorter period of disability when a fixture failed. In our experience the use of second or spare fixture reduces the duration of disability. It engenders no additional complications with minimal extra cost.

Outcome following retrosigmoid microvascular decompression of the facial nerve for hemifacial spasm.

This paper evaluates the outcome of retrosigmoid microvascular decompression of the facial nerve in a series of patients suffering from hemifacial spasm who had been referred to the skull-base team (comprising senior authors DAM and DGH). The paper is a retrospective review of 15 patients who underwent retrosigmoid microvascular decompression of the facial nerve at Addenbrooke's Hospital between 1985 and 1995. In this series it was possible to obtain complete resolution of hemifacial spasm in 93.3 per cent of cases in the short term and in 80 per cent in the long term. Twelve patients (80 per cent) were symptom-free post-operatively. Two patients had minor recurrence of symptoms occurring within six months of the procedure. One patient with no identifiable vascular impingement of the facial nerve had no improvement following surgery. Three patients suffered sensorineural hearing loss. Two patients complained of post-operative tinnitus, and transient facial palsy was noted in one patient. Retrosigmoid microvascular decompression of the facial nerve provides excellent long-term symptom control in a high percentage of patients with hemifacial spasm.

Cutaneous metastases from a hypopharyngeal malignancy.

We present an unusual case of carcinoma of the piriform fossa, presenting with cutaneous metastases. These metastases are very rare, present in the late stages of disease, and are usually associated with distant metastases and poor prognosis. They often suggest aggressive disease. We believe that cutaneous metastases from a malignancy in the piriform fossa are more unusual than those from other sites of the head and neck.

Lignocaine as a topical analgesia for post-operative nasal pack removal: a prospective, randomized, double-blind, controlled trial.

The objective of this study was to assess the efficacy of topical lignocaine in reducing the pain of pack removal after nasal surgery. Fifty-eight patients with Merocel nasal packs in situ after nasal surgery were randomized to receive 10 ml of either 2 per cent lignocaine or 0.9 per cent saline on the packs 10 minutes prior to their removal and the pain experienced on their removal was recorded on a visual analogue scale. The median pain score was 3.4 in the lignocaine group and 2.9 in the saline group with no statistical evidence of a difference between the two groups. There was no statistical evidence of an association between the group and the operation performed, the use of intra-operative Moffat's solution or the use of post-operative oral analgesia. We conclude that lignocaine used in this way does not reduce the pain of pack removal after nasal surgery.

Endoscopic dacrocystorhinostomy: long-term results and evolution of surgical technique.

This study evaluated the long-term results of endoscopic dacrocystorhinostomy (DCR) performed as a day-case procedure under local anaesthesia. It assessed the patient satisfaction with the procedure by retrospective review and a questionnaire survey. Seventy patients were referred for endoscopic DCR to the senior author between 1997 and 2000. A success rate of 92 per cent was achieved at three months and it was possible to perform 85 per cent of cases under local anaesthetic; 91 per cent were discharged on the same day. Long-term follow up by postal survey revealed that the watering eye had improved following surgery in 83 per cent (follow up range = eight to 66 months; mean = 28.6 months). Eighty-eight per cent were satisfied with the tolerability of the procedure under local anaesthesia. The authors describe changes in technique, which evolved with their experience of the procedure. Endoscopic dacrocystorhinostomy can be performed safely and successfully as a day-case procedure under local anaesthesia with excellent results and with great satisfaction to the patients.