Leishmaniasis presenting to the otolaryngologist: a rare but important cause of persistent hoarseness.

OBJECTIVE: We report a rare UK case of laryngeal leishmaniasis, mimicking laryngeal candidiasis, associated with long term steroid inhaler use. METHODS: Case report and review of the world literature concerning leishmaniasis. RESULTS: Laryngeal leishmaniasis is a protozoal infection which is rare in the Western world. It is becoming more common, however, with increased foreign travel. The disease can be difficult to diagnose histologically, and diagnosis is often delayed because of its rarity. It can mimic malignant laryngeal disease, and patients may therefore be subjected to significant and inappropriate treatment interventions. CONCLUSIONS: A diagnosis of leishmaniasis should be considered if initial treatment for persistent hoarseness is ineffective, particularly in a patient who is at low risk of malignancy.

A comparison of xylometazoline (Otrivine) and phenylephrine/lignocaine mixture (Cophenylcaine) for the purposes of rigid nasendoscopy: a prospective, double-blind, randomised trial.

OBJECTIVE: To evaluate if phenylephrine-lignocaine mixture (Cophenylcaine) nasal spray performs better than xylometazoline (Otrivine) spray for the purposes of out-patient rigid nasendoscopy preparation. DESIGN: Prospective, double-blind, randomised trial comparing visual analogue scores for out-patients receiving either phenylephrine-lignocaine mixture or xylometazoline, prior to undergoing rigid nasendoscopy as part of their assessment. SUBJECTS: Seventy-three patients requiring rigid nasendoscopy as part of their assessment were recruited to the study from Raigmore Hospital's out-patient clinic. These patients were randomised to receive a nasal spray comprising either phenylephrine-lignocaine mixture or xylometazoline, 10 minutes prior to rigid nasendoscopy. Double-blinding was adopted. After the procedure, the patient and the doctor independently completed separate visual analogue score-based questionnaires regarding the pain of the procedure and the ease of the examination, respectively. RESULTS: Analysis of the data using standardised statistical methods demonstrated that the phenylephrine-lignocaine mixture did not perform better than xylometazoline, to any statistically significant extent. CONCLUSION: Phenylephrine-lignocaine mixture is considerably more expensive and has potentially more side effects than xylometazoline. These study findings suggest that it is difficult to justify the use of phenylephrine-lignocaine mixture over xylometazoline, for nasal preparation prior to rigid nasendoscopy.

Should we be concerned about diphtheria in the UK?

Diphtheria is a very rare condition in the developed world today with the advent of immunisation. Studies from the populations of England and Wales, however, suggest a recent increase in the number of notified cases. Sore throat due to a tonsillitis is the most common manifestation and can, thus, present to the clinician. It can also present as, or be complicated by, life-threatening upper airway obstruction. This case demonstrates the former and highlights the latter, in an attempt to raise awareness of a condition which may be seen more frequently in the future.

Diagnostic and therapeutic use of the flexible nasendoscope in the management of an impacted upper oesophageal food bolus.

The flexible nasendoscope is now an integral tool in most otorhinolaryngology departments for visualizing the hypopharyngolarynx. A technique has been described using the modified Valsalva manoeuvre to improve visualization of the hypopharynx during flexible nasopharyngoscopy. The authors report an alternative technique for visualizing the upper oesophagus using the flexible nasendoscope, and highlight three cases where there was accurate visualization of an impacted oesophageal food bolus. Subsequently, these patients underwent flexible oesophagoscopy to dislodge the foreign body. The authors also describe three cases where the flexible nasendoscope was successfully used to visualize and negotiate the impacted food bolus beyond the cricopharyngeus. This is a safe and simple procedure performed without any sedation and reduces the need for prolonged hospitalization.