Neuroendocrine Adenoma of Middle Ear Causing Acute Onset Facial Palsy- A Rare Case Report.

INTRODUCTION: Acute facial nerve palsy secondary to neuroendocrine adenoma of the middle ear (NAME) is a rare disorder. There is only one case report in the literature describing similar findings. CASE REPORT: A 50-year-old man initially presented to ENT clinic with a right-sided middle ear mass and normal facial nerve function. Over the next six days, he developed House-Brackmann grade II facial paralysis. He underwent urgent surgical exploration of the tympanic cavity and excision of the middle ear mass via a post-auricular approach. Histopathological and immunohistochemical analysis revealed NAME. Three weeks after the surgery, facial nerve function returned to normal. No recurrence was found at a 3-year follow-up. CONCLUSION: Acute onset facial palsy induced by NAME is an extremely rare disorder. For a patient already affected by hearing impairment resulted from middle ear mass, facial weakness can have a significant additional detrimental impact on their wellbeing. The early complete excision of tumor is recommended not only as a curative treatment but also restoration of facial function.

A study evaluating the effects of throat packs during nasal surgery: a randomised controlled trial.

The aims of this study were to identify differences in post-operative nausea and vomiting (PONV) and throat pain between throat packed and non-packed patient groups in nasal surgery. This was a prospective, double blind, randomised controlled trial. A water-soaked throat pack gauze was inserted in the mouth to occlude the oropharynx was used in the throat pack group. The second group received no throat pack. A validated PONV questionnaire was completed 6 h post-operatively. Visual analogue scores (VAS) for throat pain were completed in recovery, 2, and 6 h post-operatively. 80 patients were enrolled (40 into each group based on power calculation). With regard to the primary outcome measure, mean PONV score for the throat pack group was 2.75 [median 0, standard deviation (SD 10.86)] and the mean PONV score for the non-packed group was 0.36 (median 0, SD 1.39). The difference in PONV was not statistically significant [P value 0.375, 95% confidence interval (CI) -1.19 to 3.32]. With regard to throat pain VAS scores (our secondary outcome measure), in recovery, the mean throat pain VAS score for the throat packed group was 2.5 (median 1, SD 2.8) and the mean throat pain VAS score for the non-throat packed group was 1.3 (median 0, SD 2.5). Statistical analysis showed a significant difference between the two groups with the throat pack group experiencing more throat pain in recovery (P value 0.018 (95% CI 1.13-2.52). At 2 and 6 h post-operatively, the mean throat pain VAS scores for the throat packed group were 2.1 and 2.3, respectively, and the mean throat pain VAS score for the non-throat packed group was 2.3 and 1.4, respectively. Statistical analysis showed non-significant difference between the two groups at 2 and 6 h post-operatively. The use of throat packs in nasal surgery does not confer PONV reduction benefit. The use of throat pack, however, is associated with a small but statistically significant more throat pain in the initial recovery period from nasal operations.

Continuity of care for orthopaedic patients in a district general hospital.

Continuity of care has been defined as a patient repeatedly consulting the same doctor and forming a therapeutic relationship. There is evidence that not only do patients value continuity of the care they receive but also that provider continuity is related to lower overall total healthcare costs and better healthcare outcomes. A retrospective audit was undertaken in James Paget Hospital, a district general hospital in East Anglia, England, to assess continuity of care from the preoperative clinic to surgery and subsequent postoperative follow-up in the orthopaedic department. Overall continuity of care by individual surgeon was 23% and by orthopaedic team (consultant and middle grade staff) 43% in the first audit cycle of 106 patients in 2008. In the second cycle in 2010, this improved to 24% and 56%, respectively, in a sample of 156 patients. Moreover, the continuity of care for trauma patients improved from 10% to 75%. Interventions which resulted in the improvement were change of on-call rota and the implementation of measures so that, following surgery, patients were allocated to the operating surgeon's clinic postoperatively. This completed audit cycle highlights the importance of continuity of care of patients and how efficient management led to a more patient centred delivery of healthcare.

Quality-of-life considerations in treatment of unresectable, recurrent head and neck cancer.

Recurrent, unresectable head and neck squamous cancer is a complex problem. Evidence for the efficacy of treatment is scant in this area and given the large number of patient and tumor variables involved in the recurrent tumor, several factors play a role in deciding the choice of management. The results of treatment are very poor and associated with significant toxicity. Thus, the quality of life outcome following treatment should play a major role in the choice of treatment. Unfortunately, generation of quality-of-life data is hampered by several factors, not least of which are the ethical issues raised by end of life care. This article reviews the relevant literature, summarizes existing evidence and draws conclusions, identifies gaps in the knowledge and offers guidance for further research.