Negative predictive value of normal nasal endoscopy for sinus disease as a cause of isolated facial pain.

OBJECTIVE: To determine the negative predictive value of normal nasal endoscopy in assessing paranasal sinus disease as the cause of isolated facial pain in the sinus regions. SUBJECTS AND METHODS: The study group comprised 42 consecutive adult patients presenting with the isolated symptom of facial pain, and a negative nasal endoscopy. Patients underwent sinus computed tomography to determine whether radiographic findings indicated a sinugenic aetiology. RESULTS: Patients comprised 27 women and 15 men, with a median age of 38 years. Twenty patients had unilateral pain, 33 per cent had sinus radiographic findings that might explain their facial pain, and 10 per cent had imaging demonstrating mucosal disease in one or more sinuses correlating with the location of the facial pain. Thirty-one per cent had anatomical radiographic findings that could potentially obstruct the osteomeatal unit. CONCLUSION: Normal nasal endoscopy had a negative predictive value of 67 per cent in excluding a sinugenic cause of isolated facial pain, if radiographically determined anatomical factors and mucosal disease were both included as positive findings; this rose to more than 90 per cent if only those patients with mucosal sinus disease were considered as true positive patients.

Selection of antibiotics after incision and drainage of peritonsillar abscesses.

Despite the fact that peritonsillar abscess is the most common complication of acute tonsillitis, the treatment of peritonsillar abscess remains controversial. One element of controversy is the choice of antibiotics after drainage of the abscess. In an attempt to assess the effect of antibiotic choice on the treatment of peritonsillar abscess, we conducted a retrospective review of records from patients with peritonsillar abscess treated with incision and drainage. Our review identified 103 patients, comprising two groups: 58 patients treated with broad-spectrum intravenous antibiotics and 45 patients treated with intravenous penicillin alone. These patients were hospitalized after incision and drainage, and therefore their clinical courses and responses to therapy could be rigorously assessed. Characterization of illness based on patient age, temperature, and white blood cell count revealed similar severity of illness between the two groups. Comparison of clinical outcomes with respect to hours hospitalized (mean 44.3 +/- 6.6 and 38.3 +/- 7.1 hours, 95% confidence interval, for broad-spectrum and penicillin groups, respectively) and mean hours febrile (16.9 +/- 5.0 and 13.3 +/- 4.2 hours, 95% confidence interval) were not statistically significantly different (p = 0.222 and 0.269, respectively) between groups, indicating that broad-spectrum antibiotics failed to show greater efficacy than penicillin in the treatment of these patients. The microbiologic characteristics of these infections, failures of therapy, and complication rates were similar to those reported in the literature. These results suggest that intravenous penicillin remains an excellent choice for therapy in cases of peritonsillar abscess requiring parenteral antibiotics after drainage.

Phonosurgery.

Phonosurgery is composed of procedures that are intended to maintain or improve the quality of the voice by correcting defects in laryngeal sound production. These procedures are rooted in a rich medical history that dates back to the early 19th century. There has been a recent convergence of physiologic principles of voice production with surgical technique theory. Recognition of this interdependence has provided a catalyst for collaboration among surgeons, scientists, speech pathologists, vocal pedagogists, and performing artists. We live in a society that is linked to effective communication, and there is a growing population of individuals who have professional voice responsibilities as part of everyday life. This has created a need for the recent developments in phonosurgery and its emergence as a subspecialty of otolaryngology.