An unusual case of dysphagia following routine electrical DC cardioversion.

Dysphagia can arise from a multitude of underlying pathologies affecting any of the three stages of swallowing; oral, pharyngeal and or oesophageal; and can be further classified as intraluminal, intramural or extramural. We discuss an unusual case of acute dysphagia secondary to haematoma formation within one of a number of potential neck spaces. We report on a novel precipitant; routine electrical cardioversion. A review of relevant anatomical boundaries, symptoms, precipitants and treatment options will be discussed.

Intratympanic gentamicin treatment in Meniere's disease: patients' experiences and outcomes.

OBJECTIVE: The aim of this study was to assess the experiences and outcomes of patients receiving intratympanic gentamicin treatment for Ménière's disease in Norfolk, UK. DESIGN: This study was based on a retrospective questionnaire survey and a review of patients' medical records. SETTING: Two district hospitals. PARTICIPANTS: All 29 patients treated between 1999 and 2001, with a minimum follow up of two years post-treatment, were included in the study. Twenty-three patients completed the questionnaires (79 per cent response rate). MAIN OUTCOME MEASURES: Glasgow benefit inventory (GBI) and vertigo symptom scale (VSS) scores, plus change in hearing thresholds. RESULTS: The mean GBI total score was +36, indicating substantial improvement in patients' overall quality of life following gentamicin treatment. The VSS scores demonstrated low levels of vertigo or unsteadiness in treated patients. Three patients suffered deterioration in their hearing thresholds following a single injection of gentamicin. However, 96 per cent of responders stated that they would be willing to have such treatment again, if necessary. CONCLUSION: Intratympanic gentamicin treatment ought to be offered to Ménière's patients suffering from disabling vertigo, with the proviso that they be made aware of the possibility of hearing deterioration.

Quality of life following microsurgery, radiosurgery and conservative management for unilateral vestibular schwannoma.

The best way to manage small and medium-sized vestibular schwannomas is currently a matter of heated debate. As these tumours are not immediately life-threatening, patients are invariably concerned about how management would affect their quality of life. Until now, no study has compared the three treatment modalities in terms of physical, psychological and social wellbeing. This study is based on a retrospective database analysis and postal questionnaire survey of unilateral vestibular schwannoma patients who had either been managed conservatively, or treated with microsurgery or radiosurgery. The results showed that: quality of life (measured by the Glasgow Benefit Inventory) deteriorated after microsurgery, particularly for small tumours; conservative management did not lead to a change in quality of life, and there was a trend towards poorer quality of life following radiosurgery. The findings suggest that a conservative management approach may be more appropriate for small tumours, and that patients who are due to undergo microsurgery or radiosurgery may benefit from counselling about the potential impact of treatment on quality of life.

Retropharyngeal haematoma causing airway obstruction: a multidisciplinary challenge.

A case of post-traumatic retropharyngeal haematoma causing airway obstruction in an elderly man on anticoagulant therapy is described. The importance of managing the airway, cervical spine and haemostatic problem with the help of a multidisciplinary team is discussed.