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J Laryngol Otol [journal]
- Samter's triad with aural involvement: a novel approach to management. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Nov 24.:1-3.
Background: Samter's triad is a well described condition manifesting as chronic rhinosinusitis with nasal polyposis, asthma and aspirin intolerance in a non-atopic individual. The underlying mechanism is still to be fully elucidated. However, aural disease has not been widely reported in these patients. In the few reported cases, most patients underwent major surgery with varying degrees of success. Case report: We report two Samter's triad patients with aural involvement. Both were successfully managed by conservative treatment, thus avoiding the need for major surgery. It appears that more Samter's triad patients may have aural disease than previously thought. Conclusion: We report good outcomes with conservative treatment, which is relevant because aural disease tends to reoccur in these patients.
- Is elective neck dissection necessary in cases of laryngeal recurrence after previous radiotherapy for early glottic cancer? [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Nov 24.:1-6.
Objectives: To assess the clinical utility of elective neck dissection in node-negative recurrent laryngeal carcinoma after curative radiotherapy for initial early glottic cancer. Methods: A retrospective review was undertaken of 110 consecutive early glottic cancer patients who developed laryngeal recurrence after radiotherapy (34 recurrent T1, 36 recurrent T2, 29 recurrent T3 and 11 recurrent T4a) and received salvage laryngeal surgery between 1995 and 2005. Results: Six patients presented with laryngeal and neck recurrence and underwent salvage laryngectomy with therapeutic neck dissection, 97 patients with recurrent node-negative tumours underwent salvage laryngeal surgery without neck dissection and only 7 underwent elective neck dissection. No occult positive lymph nodes were documented in neck dissection specimens. During follow up, only three patients with neck failure were recorded, all in the group without neck dissection. There was no significant association between the irradiation field (larynx plus neck vs larynx) and the development of regional failure. A higher rate of post-operative pharyngocutaneous fistula development occurred in the neck dissection group than in the group without neck dissection (57.2 per cent vs 13.4 per cent, p = 0.01). Multivariate logistic regression analysis showed that early (recurrent tumour-positive, node-positive) or delayed (recurrent tumour-positive, node-negative) neck relapse was not significantly related to the stage of the initial tumour or the recurrent tumour. An age of less than 60 years was significantly associated with early neck failure (recurrent tumour-positive, node-positive). Conclusion: Owing to the low occult neck disease rate and high post-operative fistula rate, elective neck dissection is not recommended for recurrent node-negative laryngeal tumours after radiation therapy if the initial tumour was an early glottic cancer.
- Clinical efficacy of tinnitus retraining therapy and cognitive behavioural therapy in the treatment of subjective tinnitus: a systematic review. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Nov 24.:1-6.
Objective: This study aimed to compare the outcomes of two frequently employed interventions for the management of tinnitus: tinnitus retraining therapy and cognitive behavioural therapy. Method: A systematic review of literature published up to and including February 2013 was performed. Only randomised control trials and studies involving only human participants were included. Results: Nine high-quality studies evaluating the efficacy of tinnitus retraining therapy and cognitive behavioural therapy were identified. Of these, eight assessed cognitive behavioural therapy relative to a no-treatment control and one compared tinnitus retraining therapy to tinnitus masking therapy. Each study used a variety of standardised and validated questionnaires. Outcome measures were heterogeneous, but both therapies resulted in significant improvements in quality of life scores. Depression scores improved with cognitive behavioural therapy. Conclusion: Both cognitive behavioural therapy and tinnitus retraining therapy are effective for tinnitus, with neither therapy being demonstrably superior. Further research using standardised, validated questionnaires is needed so that objective comparisons can be made.
- Surgical management of airway stenosis by radiofrequency coblation. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Nov 18.:1-6.
Background: Acquired airway stenosis can be challenging to manage endoscopically because of difficult field visualisation, instrument limitations and the risk of laser fire. At our institution, radiofrequency coblation has been successfully used for the resection of subglottic and tracheal stenosis in adults. This paper presents our experience with this technique. Method: A retrospective case note analysis of all cases of airway stenosis in adults from 2007 to 2012 was performed. Results: Ten adult patients underwent coblation resection for airway stenosis. All lesions were classified as McCaffrey stage I (i.e. less than 1 cm long). Causes of stenosis included: idiopathic stenosis (40 per cent), previous tracheostomy (30 per cent) and endotracheal intubation (20 per cent). Six patients (60 per cent) required a single procedure and 4 (40 per cent) required multiple interventions. All patients reported significant improvement in their symptoms following treatment. All patients were alive at the time of writing and none have required open resection. Conclusion: Radiofrequency coblation is an attractive alternative technique for the treatment of idiopathic or acquired airway stenosis in adults.
- Unilateral auditory neuropathy spectrum disorder: retrocochlear lesion in disguise? [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Nov 18.:1-7.
Objective: To investigate whether the aetiology for hearing impairment in neonates with unilateral auditory neuropathy spectrum disorder could be explained by structural abnormalities such as cochlear nerve aplasia, a cerebellopontine angle tumour or another identifiable lesion. Methods: In this prospective case series, 17 neonates were diagnosed with unilateral auditory neuropathy spectrum disorder on electrophysiological testing. Diagnostic audiology testing, including auditory brainstem response testing, was supplemented with computed tomography and/or magnetic resonance imaging. Results: Ten of the neonates (59 per cent) showed evidence for cochlear nerve aplasia. Of the remaining seven, four were shown to have another abnormality of the temporal bone on imaging. Only three neonates (18 per cent) were not diagnosed with cochlear nerve aplasia or another lesion. Three computed tomography scans were reported as normal, but subsequent magnetic resonance imaging revealed cochlear nerve aplasia. Conclusion: Auditory neuropathy spectrum disorder as a unilateral condition mandates further investigation for a definitive diagnosis. This series demonstrates that most neonates with unilateral auditory neuropathy spectrum disorder had pathology as visualised on computed tomography and/or magnetic resonance imaging scans. Magnetic resonance imaging is an appropriate first-line imaging modality.
- Role of mometasone furoate aqueous nasal spray for management of adenoidal hypertrophy in children. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Nov 18.:1-7.
Objectives: To study the role of mometasone furoate aqueous nasal spray for the management of adenoidal hypertrophy in children with more than 50 per cent obstruction, and to assess its impact on change in quality of life. Methods: A prospective, randomised, double-blind, interventional placebo-controlled study was conducted. A total of 100 children aged 2-12 years completed treatment and follow up. The symptoms and degree of obstruction were evaluated by nasopharyngoscopy conducted pre-treatment and 24 weeks post-treatment. Subjects received mometasone furoate nasal spray at a daily dose of 200 µg for 8 weeks, followed by a dose of 200 µg on alternate days for 16 weeks. Results were compared with those of a matched control group who were given saline nasal spray. Results: With mometasone treatment, there was an 89.8 per cent reduction in clinical symptom score, and the degree of obstruction dropped from 87 to 72 per cent (p < 0.0001). A statistically significant change in quality of life scores was seen in patients treated with the mometasone nasal spray (score change of 37.47) as compared with those given saline nasal spray (score change of 11.25) (p = 0.0001). Conclusion: Mometasone nasal spray appears to be effective in treating children with obstructive adenoids.
- Reducing the number of rigid bronchoscopies performed in suspected foreign body aspiration cases via the use of chest computed tomography: is it safe? A literature review. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Nov 17.:1-7.
Background: Foreign body aspiration is common and potentially life threatening. Although rigid bronchoscopy has the potential for serious complications, it is the 'gold standard' of diagnosis. It is used frequently in light of the inaccuracy of clinical examination and chest radiography. Computed tomography is proposed as a non-invasive alternative to rigid bronchoscopy. Objective: This study aimed to evaluate the accuracy and safety of computed tomography used in the diagnosis of suspected foreign body aspiration, and compare this with the current gold standard, in order to examine the possibility of using computed tomography to reduce the number of diagnostic rigid bronchoscopies performed. Method: The study comprised a review of literature published from 1970 to 2013, using the PubMed, Scopus, Web of Knowledge, Embase and Medline electronic databases. Results: The sensitivity for computed tomography ranged between 90 and 100 per cent, with four studies demonstrating 100 per cent sensitivity. Specificity was between 75 and 100 per cent. Radiation exposure doses averaged 2.16 mSv. Conclusion: Computed tomography is a sensitive and specific modality in the diagnosis of foreign body aspiration, and its future use will reduce the number of unnecessary rigid bronchoscopies.
- Sudden sensorineural hearing loss as the first manifestation of chronic myeloid leukaemia: case report. [Journal Article]
- J Laryngol Otol 2014 Nov; 128(11):1015-7.
Sudden sensorineural hearing loss rarely occurs in patients with chronic myeloid leukaemia.We present a case report of a patient who presented with sudden sensorineural hearing loss as the first manifestation of chronic myeloid leukaemia, and review the mechanisms responsible for sudden sensorineural hearing loss in leukaemic patients.A 31-year-old female presented to our clinic with unilateral sudden sensorineural hearing loss and tinnitus. Pure tone audiometry revealed profound sensorineural hearing loss in the left ear at all frequencies. During an investigation into her hearing loss, the patient was found to have chronic myeloid leukaemia.Every case of sudden sensorineural hearing loss must be carefully evaluated, and haematological disorders must be considered in the differential diagnosis of sudden hearing loss.
- Does gestational diabetes result in cochlear damage? [Journal Article]
- J Laryngol Otol 2014 Nov; 128(11):961-5.
Glucose metabolism has a significant impact on inner-ear physiology. Therefore, hearing may be affected in gestational diabetes.A matched case-control study was performed to evaluate 27 patients with gestational diabetes and 31 non-diabetic pregnant women with similar demographic characteristics. A medical history was taken for each participant, and otological inspections and high-frequency audiometry tests were performed.There were no significant differences in average pure tone air-bone hearing thresholds between the groups (p > 0.05). However, evaluation of high-frequency hearing thresholds indicated significantly increased auditory thresholds at 10 kHz and 12 kHz for right ears and at 8, 10, 12 and 14 kHz for left ears in the gestational diabetes group (p < 0.001).An investigation into cochlear damage in gestational diabetic patients showed significant high-frequency hearing loss. Further studies are needed to validate these findings in different ethnic groups and geographical populations.
- Bioinformatics, tonsillectomy and visual illusions. [Journal Article]
- J Laryngol Otol 2014 Nov; 128(11):941.