Double seal technique to obliterate the eustachian tube orifice: a novel method for the treatment of recalcitrant cerebrospinal fluid leak.

OBJECTIVE: To demonstrate a novel and effective surgical technique for the treatment of refractory cerebrospinal fluid rhinorrhoea after skull base surgery. The novel surgical technique is described and the findings of a review of relevant world English-language publications are reported. CASE REPORT: A 44-year-old woman, otherwise fit and well, presented with more than a 2-year history of right-sided facial pain. A diagnosis of classical trigeminal neuralgia was made. Surgical treatment was undertaken with a retromastoid suboccipital craniotomy. Post-operatively, the patient showed signs of right-sided cerebrospinal fluid rhinorrhoea which was recalcitrant. In light of a continuous leak and several hospital admissions, a novel technique was performed whereby the eustachian tube orifice was obliterated using an endonasal endoscopic approach. The technique proved to be successful, with no further leakage. CONCLUSION: Endoscopic obliteration of the eustachian tube using a double seal technique is a simple, safe and effective procedure in the treatment of a refractory cerebrospinal fluid leak.

Nasal sarcoidosis: a cause for a medical rhinoplasty?

OBJECTIVE: We report the use of triamcinolone injections to correct severe nasal deformity due to sarcoidosis, as an alternative to formal surgical rhinoplasty. CASE REPORT: A 30-year-old woman with a long-standing history of sarcoidosis presented to a tertiary referral rhinology clinic complaining of breathing difficulty and nasal deformity. Flexible nasoendoscopy revealed red nasal plaques typical of nasal sarcoidosis, together with significant widening of the nasal bridge. Triamcinolone, a long-acting corticosteroid, was injected both intralesionally and subcutaneously over the nasal dorsum, at zero, three and eight months, resulting in long-lasting improvement of the nasal shape. CONCLUSION: Sarcoidosis is a non-caseating, granulomatous, epithelioid inflammation. Otorhinolaryngological manifestations occur in approximately 10 per cent of patients; however, there is little published experience of nasal reconstruction in such patients. We describe a quick, simple and relatively cost-effective technique, with little or no co-morbidity, with which to improve the aesthetic and symptomatic outcomes of nasal sarcoidosis.

An objective evaluation of the waterproofing qualities, ease of insertion and comfort of commonly available earplugs.

Earplugs are commonly recommended to protect the middle ear from water in patients with exposed middle ears. This study assessed the waterproofing qualities, ease of insertion and comfort of six commonly available earplugs. Ten subjects (20 ears) were assessed by placing a pre-weighed neurosurgical pattie in their cleaned ear canal under microscope guidance. The subjects underwent a standardized head wetting regime. The outer ear was dried, earplug and pattie removed and pattie reweighed. The difference in weight was calculated. The subjects were also asked to score the difficulty of insertion and comfort of the earplugs on a visual analogue scale. The results show a significant difference in the waterproofing qualities of the various types of earplugs. Cotton wool with petroleum jelly was the most effective (P < 0.001). It was also the easiest to insert and the most comfortable for the subject (P < 0.001).