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The Journal of laryngology and otology [journal]
- 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.
- Australian training for contemporary airway management of obstructive sleep apnoea in ENT surgery: current status and future recommendations. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Nov 17.:1-8.
Background: The identification and treatment of adult obstructive sleep apnoea and other sleep-related breathing issues demands nuanced clinical judgement to determine if surgery is appropriate and which surgery should be performed. No study to date has evaluated the sleep medicine curriculum from the perspective of the Australian ENT surgical trainee, or addressed potential strategies for improving levels of surgical skill and knowledge in this field. Methods: A cross-sectional survey was used to assess knowledge of sleep surgery in trainees enlisted with the Australian Society of Otolaryngology Head and Neck Surgery. After a cadaver dissection workshop on the latest reconstructive surgical techniques in adult OSA, a second survey was used to assess changes in the likelihood of applying techniques. Results: Overall, trainee confidence, knowledge and exposure to sleep-disordered breathing cases averaged below 50 per cent. The cadaver dissection workshop achieved consistent improvements in all areas assessed. Conclusion: Low confidence and lack of exposure to sleep surgery cases for ENT trainees supports a broadening of the Australian Society of Otolaryngology Head and Neck Surgery curriculum. This paper outlines possible ways to improve this situation.
- Intratympanic steroid injection as a salvage treatment for sudden sensorineural hearing loss. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Nov 17.:1-6.
Objective: To determine the efficacy of intratympanic methylprednisolone injections for treating sudden sensorineural hearing loss. Method: A retrospective chart review was performed to identify patients suffering from sudden sensorineural hearing loss with no recovery after oral steroids. Patients were given up to three intratympanic methylprednisolone injections at one-week intervals. They were classified according to their functional hearing class, remission was monitored and potential factors affecting prognosis were analysed. Results: Intratympanic injections provide effective salvage therapy for sudden sensorineural hearing loss (p = 0.039). Changes in pure tone average and speech discrimination score were analysed following intratympanic methylprednisolone injections. The pure tone average reached a plateau after the second injection; however, the speech discrimination score improved until after the third injection. Hearing improvement after intratympanic injections mainly occurred at low frequencies. The interval between symptoms appearing and intratympanic injections starting was not significantly associated with remission (p = 0.680). Conclusion: A delay between symptom onset and the first intratympanic methylprednisolone injection does not seem to affect prognosis.
- Unilateral vocal fold paralysis: can laryngoscopy predict recovery? A prospective study. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Nov 17.:1-10.
Objective: To determine the prognostic value of laryngoscopy in predicting the recovery of unilateral vocal fold paralysis. Method: A prospective study was carried out of all patients with unilateral vocal fold paralysis without a progressive lesion or arytenoid dislocation. Results: Among the 66 candidates, 15 recovered. Patients with interarytenoid paralysis (p < 0.001) or posterolateral tilt of the arytenoid (p = 0.028) had less chance of recovery. Among 51 patients who did not recover, 25.49 per cent regained phonatory function by compensatory movement of the normal side; the rest required an intervention. Intervention requirement was significantly less for those patients who had isolated glottic level compensation. The paralysed vocal fold was at the same level in 32.35 per cent of patients, higher in 38.23 per cent and lower in 29.42 per cent. In those in whom vocal folds were in the abducted position (46.67 per cent), the affected vocal fold was at a lower position on phonation. Inter-observer reliability assessment revealed excellent to good agreement for all criteria. Conclusion: Interarytenoid paralysis and posterolateral tilt of the arytenoid were predictors of poor recovery.