Measurement of health status in patients with vertigo.

In order to assess how much disability is caused by vertigo, health status scores of patients referred with dizziness or vertigo were compared with local population normative data and with the severity of illness, measured by a disease-specific questionnaire. The questionnaires were administered by post to patients awaiting an ENT out-patient appointment. There was a strong correlation (P = 0.001) between the eight dimensions of the SF-36 (Mos 36 item short-form health survey) and disease severity, measured by the Dizziness Handicap Inventory questionnaire. Compared with the general population, vertigo sufferers had significant role limitation due to physical problems and social functioning (men) and physical problems and vitality (women). General health status is significantly affected by both the presence and severity of vertigo and the SF-36 may prove useful in assessing outcomes.

Submental abscess: an unusual delayed complication of primary Blom-Singer valve insertion.

Voice restoration following laryngectomy can be achieved by the now well accepted technique of inserting a 'Blom-Singer' prosthesis through a tracheo-oesophageal fistula created either primarily or secondarily. Recognized complications of primary puncture and valve insertion include haemorrhage, oesophageal perforation, peristomal cellulitis and aspiration of saliva. We describe the previously unreported complication of a submental abscess developing probably as a result of air being forced from the fistula up between the trachea and the pharynx, this plane not having fully healed as a result of previous radiotherapy. The problem was compounded by the patient's over-zealous attempts to phonate. To prevent this problem arising in future we recommend leaving the fistula at least six weeks to mature before inserting the valve, when the patient has had previous radiotherapy, and encouraging relaxation when learning to phonate with this technique.

The feeding pharyngostomy: an alternative approach to enteral feeding.

We present a six-year retrospective review of feeding pharyngostomies as performed in this department. The indications, technique and complications of this procedure are discussed.

Wound amylase estimation and the prediction of pharyngocutaneous fistulae.

Pharyngocutaneous fistula is a common complication after major head and neck surgery. In this study it was possible to predict fistula formation as early as the second postoperative day, using serial measurements of the amylase concentration in wound drainage. Wound amylase estimation may be used to help avoid major pharyngocutaneous fistulae by providing an 'early warning' and allowing modification of the postoperative feeding regimen in certain situations.

Effect of weather conditions on acute laryngotracheitis.

The aim of the study was to examine the incidence of croup in the Swansea area and to determine whether meteorological factors have any effect on the incidence of acute laryngotracheitis requiring hospitalization. 447 patients with a diagnosis of acute viral croup were admitted to the Ear, Nose and Throat Department of Singleton Hospital, Swansea, between January 1st 1980 and December 31st 1984. There was no significant difference between days with and without croup admissions, with respect to barometric pressure or relative humidity. Maximum and minimum temperatures were significantly lower on days with croup admissions (p less than 0.001). Wind direction appeared to influence the number of admissions, which were increased when the wind was from the south-east (p less than 0.01).

Prediction and prevention of fistulae after major head and neck surgery: a preliminary report.

A method of checking the integrity of mucosal repair after head and neck surgery using wound amylase levels is described. A low wound amylase concentration allows early resumption of oral intake; an increasing amylase concentration is a strong predictor of subsequent wound breakdown and fistula formation. A regimen has been developed which has prevented fistulae from developing in the small number of patients studied thus far.

Low-powered ultrasound in the inhibition of tinnitus.

An experiment was performed using low-level ultrasound in an attempt to inhibit tinnitus during and after stimulation. The method used a double-blind crossover technique with a placebo. Forty subjects were tested, and they generally reported little or no change in their tinnitus, the results from placebo and ultrasound not being statistically different. It cannot be concluded, therefore, that the ultrasound we were using has any beneficial effect on tinnitus. These results do not confirm the findings of the pilot study using the same ultrasound devices (Carrick et al., 1986).

Low-powered ultrasound in the treatment of tinnitus: a pilot study.

The aim of this study was to determine whether a low dose of ultrasound, applied over the mastoid bone, caused a subjective improvement in the level of tinnitus in long standing tinnitus sufferers. Forty patients from the Swansea Tinnitus Association volunteered to take part in a double blind crossover trial. They received a 10-minute treatment with an ultrasound generator and an identical placebo device on two separate visits. The devices were randomly allocated on the first visit. At each visit the patient noted whether their tinnitus was completely improved, slightly improved, unchanged or made worse by the treatment. Forty per cent of patients who completed the trial were improved by ultrasound, 7% by placebo. Low powered ultrasound was significantly better at producing improvement than placebo (P less than 0.02 Binomial Test).

The effect of adenoidectomy on nasal resistance to airflow.

The aim of the research was to determine whether the operation of adenoidectomy affected the nasal resistance to airflow. The total nasal respiratory resistance (TNR) was measured in forty-four children admitted for adenoidectomy and myringotomies, with or without tonsillectomy. The measurement was repeated three months post-operatively. There was significant correlation between the pre-operative TNR and the weight of adenoid removed at operation. A history of snoring pre-operatively, which was absent after operation, was related to a high pre-operative TNR and large adenoids. Those children in whom at least one gram of adenoid tissue was removed, were found to have a mean reduction in nasal resistance of 19%.