Management of chondrodermatitis nodularis chronica helicis using a 'doughnut pillow'.

UNLABELLED: Chondrodermatitis nodularis chronica helicis is a well-recognised painful condition of the pinna. There have been several modes of treatment described for this condition. Although the most common mode of treatment is surgery,1,2 several conservative approaches have also been tried. OBJECTIVES: To determine if chondrodermatitis nodularis chronica helicis can be treated conservatively using a doughnut-shaped pillow. DESIGN AND SETTING: Prospective study in Wrexham Maelor Hospital, which is a district general hospital. PARTICIPANTS: All the patients clinically diagnosed with chondrodermatitis nodularis chronica helicis between September 2003 and September 2004. All such patients were seen by an ENT consultant with a special interest in facial lesions. Patients who could not be clinically diagnosed with chondrodermatitis nodularis chronica helicis were excluded from the study. MAIN OUTCOME MEASURE: Pain relief following the use of a doughnut pillow was used as the main outcome measure. RESULTS: Twenty-three (14 female and 9 male) patients were treated with a special doughnut-shaped pillow designed to relieve the pressure on the affected ear. Of the 23 lesions treated 13 remained pain free after a follow-up period of one year. CONCLUSION: Conservative treatment of chondrodermatitis nodularis chronica helicis using a doughnut pillow is very cost effective.

Severe congenital laryngeal hypoplasia in a 45-year-old man.

Congenital laryngeal anomalies are rare. They usually present in infancy and early childhood. We present a case of severe congenital hypoplasia, with multiple anomalies of the laryngeal cartilages in a 45-year-old man.

Bone pate repair of the eroded incus--five years on.

Seventy-four patients undergoing bone pate repair of the long process of the incus as part of a tympanoplasty are presented. Mean follow-up time was 66 months (range 12-143 months). Hearing results are averaged over the frequencies 500, 1000, 2000 and 4000 Hz. Thirty-two per cent of the patients had hearing thresholds better than 30 dB pre-operatively. A significant improvement in hearing was seen (p < 0.001). The data were also analysed to assess the effect of the pre-operative state of the tympanic membrane on the final result. The pre-operative condition of the tympanic membrane was either perforated (35 ears) or atrophic (33 ears). Six tympanic membranes were intact but these were excluded from the final results. No difference in hearing result was found between patients who had an ossicular repair in combination with either a perforated tympanic membrane repair or an atrophic membrane repair. Average hearing gain in the perforated group was 13 dB, in the atrophic group 9 dB and in the intact group 7 dB.

Sinus computerized tomography in primary hypogammaglobulinaemia.

Thirteen patients suffering from primary hypogammaglobulinaemia receiving intravenous immunoglobulin replacement therapy underwent computerized tomography of the paranasal sinuses. The CT scans were evaluated and related to clinical data from the patients, who were selected for study on the basis of having symptoms of rhinosinusitis. The scans varied from normal to demonstrating widespread sinus abnormality. There was no relationship between the scan findings and duration of ENT symptoms, range of current symptoms, or the interval between the onset of ENT symptoms and the start of intravenous immunoglobulin replacement therapy. It is nevertheless possible that prompt institution of replacement therapy, after correct diagnosis early in the course of the disease, may prevent the development of sinus disease refractory to such treatment.

Spontaneous retropharyngeal haematoma: two cases and a review of the literature.

Retropharyngeal haemorrhage is a rare condition. The classical picture is described as a triad of features; superior mediastinal obstruction, anterior displacement of the trachea on a plain X-ray of the neck and subcutaneous bruising appearing on the neck and spreading on to the chest wall (Sandor and Cooke, 1964). Two cases are reported here, neither of which had mediastinal compression. The available literature is summarized.

Bilateral metastatic endophthalmitis as a complication of major burns.

Metastatic infection of the eye is a rare complication of burns. The following report describes a patient with endophthalmitis occurring as a complication of major burns. The diagnostic difficulties that arose are discussed and the recommended treatment outlined.

A five year follow up of incus transposition in relation to the first stage tympanoplasty technique.

This study was set up, prospectively, to determine factors affecting the long-term hearing results of patients undergoing incus transposition as a second stage in ossicular reconstruction, following a successful drumhead repair in non-cholesteatoma ears. Seventy-one patients were entered into the study over five years from 1980-1985, 66 were available to be studied throughout the five year follow-up period. Nine weeks post-operatively, 74 per cent of all patients has an air-bone gap of less than 15 dB (48/66). The type of first stage procedure had a significant effect on the hearing levels in the final five year assessment. The most successful sub-group were those patients who had a cortical mastoidectomy and silastic sheeting inserted in the first staging procedure. The air-bone gap, of less than 15 dB, was maintained in 71 per cent of this group (17/24). The sub-group who had a simple myringoplasty as the primary procedure had a good initial hearing level. By five years, however, only 30 per cent of the patients had maintained the air-bone gap of less than 30 dB (3/11).

The microbiology of peritonsillar sepsis.

Pus obtained by needle aspiration of 91 peritonsillar abscesses was examined microbiologically. A positive culture was obtained in 55 patients (60 per cent). Sixty-four bacteriological isolates were grown. Forty patients had a pure growth of a single organism, of which 21 (53 per cent) were beta Haemolytic streptococci. Pure growths of Staphylococcus aureus were found in only three patients. Fifteen patients had mixed organisms, including anaerobes, in their pus and the resistance to penicillin was low. Only the bacteroides species were generally penicillin resistant. The vast majority of patients made a good recovery following needle drainage of the abscess and treatment with parenteral penicillin. The patients with a mixture of penicillin sensitive and penicillin resistant organisms also made a good clinical recovery following needle drainage and administration of parenteral penicillin. The relevance of these findings in the pathogenesis and management of peritonsillar sepsis is discussed.

The management of peritonsillar sepsis by needle aspiration.

172 consecutive patients admitted with suspected unilateral peritonsillar sepsis were studied. Needle aspiration of the peritonsillar space was performed, and they were all then treated with intravenous antibiotics (usually benzylpenicillin). Any pus obtained was cultured. The aspiration was repeated if the patient was not improving after 24 h. A quantity of pus was aspirated at the first attempt from 91 patients (53%); 82 of these required no further aspiration but 7 required a further single aspiration and 2 required a further 2 aspirations before resolution of the sepsis. 71 of the 81 patients (88%) from whom pus had not been aspirated, and who were therefore initially considered to have peritonsillar cellulitis, required no further aspirations. However, 6 subsequently drained pus spontaneously and 4 produced a positive aspirate on a second occasion. Four patients required a change in their antibiotic therapy. We have found the combination of needle aspiration and parenteral antibiotics to be an effective treatment of peritonsillar sepsis. All patients were spared the unpleasant and painful experience of an incision and drainage procedure.

Do patients presenting to accident and emergency departments have low serum anticonvulsant concentrations?

It is often felt that poorly controlled epileptic patients, who are taking anticonvulsant medication, are over represented in A&E departments compared to the general population. This A&E based study set out to determine whether such patients do have inadequate serum anticonvulsant levels, when they present following a seizure, to A&E departments. All epileptic patients, taking medication, who presented to the A&E departments of St. Bartholomew's and Hackney Hospitals, London, over a 4-month period were studied. Serum anticonvulsant concentrations were measured on their arrival in the departments. Forty-six patients were studied. Only 21% of anticonvulsant drug concentrations were within 'therapeutic' ranges. A total of 66% were below 'therapeutic' ranges and 13% were potentially toxic. The implication of these findings is discussed.

Fanconi's anaemia and post-cricoid carcinoma.

A case of post-cricoid carcinoma, occurring in a patient with Fanconi's anaemia is presented. The case illustrates the rare association of the two diseases. The problems with the management of such a case are discussed.

Role of routine fluid replacement in children undergoing tonsillectomy.

It has been suggested that children undergoing tonsillectomy would benefit from an intravenous infusion, to counteract the period of pre-operative fasting combined with the blood loss at operation. A prospective study of 50 children undergoing tonsillectomy was undertaken. The children were randomly allocated into two groups, one to receive an infusion and a control group. There were no significant differences between the two groups, although the children with an infusion had a longer mean post-operative stay. There would seem to be no role for routine intravenous fluid replacement in children undergoing uncomplicated tonsillectomy.