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The Journal of laryngology and otology [journal]
- An alternative approach to primary rhinoplasty using Walsham forceps. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Oct 17.:1-2.
Background: The successful execution of lateral osteotomies in rhinoplasty is an important step that can influence the functional and aesthetic outcome of the procedure. Objective: This paper describes an alternative method for achieving mobilisation of the nasal bones by careful application of Walsham forceps during primary rhinoplasty.
- Effects of functional endoscopic sinus surgery on chronic rhinosinusitis resistant to medication. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Oct 17.:1-5.
Objective: To evaluate the therapeutic effects of functional endoscopic sinus surgery in patients with chronic rhinosinusitis who were unresponsive to medical treatment. Methods: A total of 232 patients were divided into 2 groups: a functional endoscopic sinus surgery group (n = 162) and a conservative therapy group (n = 70). Efficacy was assessed in terms of Lund-Kennedy endoscopy scores and Sino-Nasal Outcome Test 20 symptom scores. Results: In the functional endoscopic sinus surgery group, Lund-Kennedy and Sino-Nasal Outcome Test 20 scores were significantly lower at 3, 6 and 12 months post-surgery compared with baseline scores. In the conservative therapy group, both sets of scores were significantly lower at 3 months, but not at 12 months. In this latter group, the Lund-Kennedy scores decreased only slightly and the Sino-Nasal Outcome Test 20 scores significantly decreased at six months compared with initial scores, indicating disparity between the subjective and objective measures. Patient-reported symptom improvement was better in the functional endoscopic sinus surgery group than in the medication group at 12 months (p < 0.001). Conclusion: These findings suggest that functional endoscopic sinus surgery has better efficacy over a longer period compared with conservative therapy.
- New laryngoscope for endoscopic arytenoidectomies. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Oct 15.:1-5.
Objective: During an endoscopic arytenoidectomy, an intubation tube must be elevated anteriorly with the laryngoscope to ensure an adequate surgical field. This paper describes a new laryngoscope that has a canal along the outer wall of the body and a ridge which runs along the canal. Method: Ten patients underwent endoscopic total arytenoidectomy using this new laryngoscope and 10 patients underwent the same operation using a regular laryngoscope. Results: The duration of all operations ranged between 25 and 65 minutes, with a median duration of 42.5 minutes. The median duration with the new laryngoscope was 39 minutes, and that with the regular laryngoscope was 49 minutes; this difference was statistically significant (p < 0.05). Conclusion: This new laryngoscope shortened the duration of the endoscopic arytenoidectomy and facilitated the procedure by enlarging the surgical field. This new laryngoscope may be a beneficial surgical instrument for posterior endoscopic laryngeal operations.
- Re-irradiation in head and neck cancers: an Indian tertiary cancer centre experience. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Oct 15.:1-7.
Objective: To explore the treatment outcomes of patients treated with re-irradiation for recurrent or second primary head and neck cancer. Method: An analysis was performed of 79 head and neck cancer patients who underwent re-irradiation for second primaries or recurrent disease from January 1999 to December 2011. Results: Median time from previous radiation to re-irradiation for second primary or recurrence was 53.6 months (range, 2.7-454.7 months). Median age at diagnosis of first primary was 54 years. Median re-irradiation dose was 45 Gy (range, 45-60 Gy). Acute grade 3 or worse toxicity was seen in 30 per cent of patients. Median progression-free survival for recurrent disease was 15.0 months (95 per cent confidence interval, 8.33-21.66). The following factors had a statistically significant, positive impact on progression-free survival: patient age of less than 50 years (median progression-free survival was 29.43, vs 13.9 months for those aged 50 years or older; p = 0.004) and disease-free interval of 2 years or more (median progression-free survival was 51.66, vs 13.9 months for those with less than 2 years disease-free interval). Conclusion: Re-irradiation of second primaries or recurrences of head and neck cancers with moderate radiation doses yields acceptable progression-free survival and morbidity rates.
- Treatment of vertigo and postural instability using visual illusions. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Oct 15.:1-3.
Background: Ototoxicity caused by medication can lead to debilitating symptoms such as dizziness, vertigo and postural instability. There is no current 'gold standard' treatment available. Case report: A 79-year-old male, with bilateral loss of vestibular function caused by gentamicin toxicity after surgery for prosthetic valve endocarditis, complained of dizziness, difficulty in walking and an increased risk of falling. Physical examination showed a positive head thrust test suggesting bilateral loss of vestibular function. Results: The patient underwent a specific motion-based virtual reality enhanced protocol for peripheral vestibular disease. He showed a great improvement, with a 50 per cent reduction in his Dizziness Handicap Inventory score. Conclusion: Computer-aided rehabilitation programmes might represent an important advance in gait and posture training.
- Development of a physiotherapy-led balance clinic: the Aintree model. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Oct 14.:1-6.
Objective: To create a 'one-stop' clinic in which assessment, diagnosis, treatment and therapies for most patients presenting with balance and dizziness disorders are delivered simultaneously. Methods: Patients triaged via referral letters were selected to attend the balance clinic, which is led by specialist balance physiotherapists. Patients were seen by an audiologist, and a 'balance' ENT consultant was available for joint consultations when required. Further details of the clinic set up are discussed. Results: Over an 18-month period, 200 new 'dizzy' patients attended the clinic. Benign paroxysmal positional vertigo and labyrinthitis were the commonest diagnoses. Fifty per cent of all patients were discharged after a single clinic visit. Questionnaires showed that patient satisfaction was high. Conclusion: The physiotherapy-led balance clinic has reduced patient waiting times to be seen, has a high level of patient satisfaction and is economically beneficial.
- A study on allergen sensitivity in patients with allergic rhinitis in Bangalore, India. [Journal Article]
- J Laryngol Otol 2014 Oct; 128(10):892-6.
Allergic rhinitis is the most common form of non-infectious rhinitis, affecting 500 million people worldwide, with one-fifth of those affected living in the Indian subcontinent. The skin prick test is the most valuable test for detecting offending allergens, and can be helpful for patient education, allergen avoidance and immunotherapy planning.The skin prick test was performed with 49 allergens in 486 patients who presented with symptoms of allergic rhinitis, and the allergen profile was studied.Of the 486 allergic rhinitis patients, 335 (68.93 per cent) showed allergen positivity to the skin prick test. Dust mite was the most common allergen, with positive results in 44.65 per cent of cases.The most common offending allergen in our study was the dust mite. Identification of specific allergens for a particular geographical area aids patient education and enables allergen-specific immunotherapy.
- Introducing bioinformatics. [Journal Article]
- J Laryngol Otol 2014 Oct; 128(10):847.
- Should the duration of head bandaging be reduced after pinnaplasty? A systematic review. [JOURNAL ARTICLE]
- J Laryngol Otol 2014 Oct 13.:1-4.
Background: It is common practice to use head bandages for 7-10 days following pinnaplasty. However, head bandages are often troublesome for patients and can lead to serious complications. Method: A systematic review was performed to evaluate the use of head bandages after pinnaplasty. A search of Medline, Embase (Ovid) and CINAHL (EBSCO collections), the Cochrane Library, Pubmed (US National Library of Medicine) and Google Scholar identified 34 related articles. Of these, 14 were deemed relevant and 2 randomised controlled trials, 1 cohort study, 3 case series and 1 literature review met the inclusion criteria. Results: The two randomised controlled trials show no statistically significant difference in complications when a head bandage was used for the standard 7-10 days, for 24 hours or not at all. The three case series show that using a head bandage for 24 hours or not at all are safe alternatives. The review article recommended that when head bandages are applied after pinnaplasty it should be for the shortest duration possible. Conclusion: Based on the available evidence, not using a head bandage at all or using one for a maximum of 24 hours following pinnaplasty is recommended.