Otological and vestibular symptoms in patients with low grade (Quebec grades one and two) whiplash injury.

OBJECTIVE: To establish the prevalence of new vestibular and otological symptoms in a group of patients who had sustained a low grade (Quebec grades one or two) whiplash injury. METHODS: A retrospective review of the case records of 109 patients undergoing assessment by a single practitioner for the purposes of compiling a medicolegal report on their whiplash injury. RESULTS: Four patients complained of short-lived, non-specific dizziness symptoms in the acute phase following their original injury. There were no reports of vertigo, tinnitus or hearing loss after a mean period of 149 days following the whiplash injury. CONCLUSIONS: No patients reported otological or persistent vestibular symptoms in the acute phase following their whiplash injury. This suggests that caution should be exercised when attributing these symptoms to such an injury. Before whiplash injuries are admitted as an aetiological factor in the development of such symptoms, other causes should be excluded.

Major ear surgery in a paediatric day care unit.

Abstract Traditionally major ear surgery in children has been regarded as an in-patient procedure. Evidence from the USA for adults, however, concludes that it is both safe and effective to perform many major ear procedures as day cases. We have been carrying out major ear operations on children as day cases routinely for six years in a dedicated children's day unit and examined our data to find out whether it was both safe and feasible to perform major ear surgery in children on a day-case basis. As our main outcome measure we used the rate of unplanned admissions. We found that the unplanned admission rate for surgery, excluding mastoid surgery, was 6.7 per cent and that procedures such as myringoplasty, ossiculoplasty, bilateral pinnaplasty, meatoplasty and tympanotomy with excision of cholesteatoma, were eminently suitable for day surgery.

Masked pseudomonal skull base osteomyelitis presenting with a bilateral Xth cranial nerve palsy.

Skull base osteomyelitis classically presents as a complication of severe external otitis, middle ear, mastoid or sinus infection and can lead to multiple lower cranial nerve palsies when the jugular foramen is involved as a consequence of widespread involvement of the skull base. Bilateral skull base osteomyelitis is a recognized phenomenon, but has not previously been reported secondary to pseudomonal infection in the absence of a clinically obvious focus of infection. We report the case of a 77-year-old diabetic patient who presented with dysphonia and dysphagia and had a bilateral Xth cranial nerve palsy. No focus of infection was evident on presentation. Subsequent radiological investigation confirmed the diagnosis of bilateral skull base osteomyelitis.

Novel use of nebulised adrenaline in the treatment of secondary oropharyngeal haemorrhage.

We report the use of nebulised adrenaline in the treatment of secondary oropharyngeal haemorrhage. Cases involving two adults and one child are presented to illustrate the usefulness of this technique in helping to achieve haemostasis without the need for a general anaesthetic. The mechanisms of the haemostatic action of adrenaline are also explored. We believe that in selected cases nebulised adrenaline is both safe, effective and easily tolerated and represents a useful additional tool in the treatment of oropharyngeal haemorrhage.

Tracheal stenosis due to brachiocephalic artery aneurysm successfully treated with stenting.

Tracheal stenosis secondary to an aneurysm of the great vessels is a rare presentation, previously thought to be unremediable to tracheal stenting. The introduction of covered, expandable, metallic stents has led to the successful treatment of a patient with tracheal stenosis secondary to an aneurysmal brachiocephalic artery without resorting to major cardiothoracic surgery.