1
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Abstract
The surgical management for otosclerosis has evolved from stapes mobilisation to total extraction of the footplate, the so called 'stapedectomy', to a small hole in the stapes footplate, the 'stapedotomy'. The aim of stapes surgery is to restore the vibration of fluids within the cochlear canal. Revision stapedectomy should be approached with caution. Stapedectomy can lead to some minor and other more serious complications.
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Affiliation(s)
- Y Bajaj
- Department of ENT, York Hospital, York, UK.
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2
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Abstract
The rationale for medical therapy for otospongiosis is to slow down and eventually stop the phase of bone resorption. There is some increase in the incidence of stapedial otospongiosis in a low-fluoride area compared with a high-fluoride area. Sodium fluoride treatment has a role to play in preventing the onset and progression of hearing loss in patients suffering from otosclerosis. Sodium fluoride therapy has been shown to have some beneficial effect on dizziness associated with otosclerosis. In view of the possibility of systemic side effects of sodium fluoride therapy, a regular follow up of patients is warranted. Biphosphonates can be used as an alternative treatment to sodium fluoride in cases where the patient is intolerant to sodium fluoride therapy. Hearing aid is also a treatment option, but it does not halt the disease process.
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Affiliation(s)
- S Uppal
- Department of ENT, York Hospital, York, UK.
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3
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Abstract
Otosclerosis is a bone dystrophy localised to the inner ear and the stapes footplate. Otosclerosis is a frequent cause of deafness in adults. The patient with otosclerosis typically presents with a history of slowly progressive conductive or mixed hearing loss that is usually bilateral and often asymmetric, usually between the ages of 15 and 45 years. The disease is characterised by alternating phases of bone resorption and formation. The majority of studies on families with otosclerosis suggest an autosomal dominant mode of inheritance with incomplete penetrance.
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Affiliation(s)
- S Uppal
- Department of ENT, York Hospital, York, UK
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4
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Shayah A, Coatesworth AP. Re: The role of ENT surgeons in snoring assessment: some prospective preliminary evidence. Clin Otolaryngol 2009; 34:165; author reply 165-6. [PMID: 19413620 DOI: 10.1111/j.1749-4486.2009.01885.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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5
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Agada FO, Ayoubi N, Coatesworth AP. Response to Amin et al. Clin Otolaryngol 2008; 33:285-6; author reply 286. [PMID: 18559042 DOI: 10.1111/j.1749-4486.2008.01620.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Lee CA, Mistry D, Sharma R, Coatesworth AP. Rhinological, laryngological, oropharyngeal and other head and neck side effects of drugs. J Laryngol Otol 2007; 120:e6. [PMID: 16917983 DOI: 10.1017/s0022215105005839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Following a previous paper in which we documented the otological side effects of drug therapy, we here review other drug side effects that ENT surgeons may encounter when dealing with patients. Although otological drug side effects such as hearing loss and tinnitus are well recognized there are many rhinological, laryngeal, oropharyngeal and other head and neck drug side effects. Our data were sourced from the British National Formulary and Electronic Medical Compendium websites.
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Affiliation(s)
- C A Lee
- Department of Otolaryngology, York Hospital, York, UK.
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7
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Abstract
Many patients who present with otalgia have a normal otological examination, and a distant source of pain must be considered. The ear receives an extensive sensory innervation arising from six nerve roots. Many other structures in the head, neck and thorax share a common neuronal pathway with the ear, and these tissues represent the possible sites of disease in the cases of referred otalgia. Consequently, the differential diagnosis is extensive and varied. Making an accurate diagnosis relies on an understanding of the complex distribution of nerve fibres and a structured approach to patient assessment. This article aims to classify the aetiology of referred otalgia and to outline current treatments for these conditions. The origins of referred otalgia may be as remote as the cranial cavity and thorax; however, dental disease, tonsillitis, temporomandibular joint disorders and cervical spine pathology represent the most frequent causes. Ear pain may also be the first sign of a head and neck malignancy. Patients complaining of otalgia, with risk factors for an aerodigestive neoplasm, and a normal ENT examination require an urgent otolaryngological opinion.
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Affiliation(s)
- S D Charlett
- ENT Department,James Cook University Hospital, Middlesbrough, UK.
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8
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Abstract
Cowden disease is a genetically inherited disorder presenting with multiple hamartomatous and neoplastic lesions in various organs and tissues. We present a review of the diagnostic criteria, clinical presentation, genetics, and management of this condition.
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Affiliation(s)
- S Uppal
- Molecular Medicine Unit, University of Leeds, St. James's University Hospital, Leeds, UK.
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9
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Abstract
We describe a series of four patients who presented with 'high globus pharyngeus', who all had an abnormally curled epiglottis tip touching and indenting the tongue base. The actual incidence of 'curling epiglottis', as well as the potential impact of this variation in persistent globus symptoms, is not known. We therefore describe for the first time a series of patients with this anatomical variant of the epiglottis, each of whom experienced unresolved globus symptoms despite receiving intensive medical treatment. In the literature, the success rate for improvement in symptoms following medical treatment ranges from 68 to 80 per cent. Following CO2 laser partial epiglottectomy, all four patients experienced complete relief of their symptoms. We advocate consideration of this treatment for high globus pharyngeus that fails to respond to conservative treatment, in cases with proven curled epiglottis on endoscopic examination.
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Affiliation(s)
- F O Agada
- Department of Ear, Nose and Throat/Head Neck Surgery, York Hospital, York, UK.
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10
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Davies J, Coatesworth AP. Double-blind randomized controlled study of coblation tonsillotomy versus coblation tonsillectomy on post-operative pain. Clin Otolaryngol 2006; 30:572; author reply 572-3. [PMID: 16402995 DOI: 10.1111/j.1749-4486.2005.01117.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Charlett SD, Moor JW, Jenkins CN, Coatesworth AP. A quartet of lateral sinus thrombosis, extradural abscess, subdural abscess and occipital abscess: complications of acute mastoiditis in a pre-adolescent child. J Laryngol Otol 2006; 120:781-3. [PMID: 16859571 DOI: 10.1017/s0022215106002271] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/14/2006] [Indexed: 11/07/2022]
Abstract
Neurological complications of acute mastoiditis are rare but can be life threatening. Their presentation may be masked by the use of antibiotics. We present a unique case of acute otitis media progressing to occipital, extradural and subdural abscess formation and lateral sinus thrombosis in a child. The clinical course and management of a pre-adolescent male is presented and discussed. We review the incidence, presentation and treatment of occipital abscesses and lateral sinus thrombosis with acute mastoiditis. Following extended cortical mastoidectomy, neck exploration and broad spectrum intravenous antibiotics, the patient made a full recovery. This is the first reported case of acute mastoiditis associated with occipital abscess in a child. Early, aggressive treatment is required for a successful outcome. The rarity of neurological complications, in addition to the insidious onset and subtle symptoms associated with antibiotic therapy, can make diagnosis extremely difficult. Patients with acute otitis media who fail to respond fully to treatment should be referred early for a specialist otology opinion.
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12
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Abstract
This paper describes a technique for managing a preauricular abscess that allows drainage of the pus, with little or no disturbance to the underlying sinus, making any subsequent surgery more straight forward.
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13
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Nadig SK, Uppal S, Back GW, Coatesworth AP, Grace ARH. Foreign body sensation in the throat due to displacement of the superior cornu of the thyroid cartilage: two cases and a literature review. J Laryngol Otol 2006; 120:608-9. [PMID: 16681864 DOI: 10.1017/s0022215106001125] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/29/2005] [Indexed: 11/05/2022]
Abstract
The sensation of a foreign body in the throat when swallowing is a common and very discomforting symptom for those who experience it. Common causes are gastroesophageal reflux disease and possibly upper oesophageal dysmotility. This complaint may be dismissed as psychogenic when a cause for the problem is not readily apparent.We present two cases in which the patient had a foreign body sensation in the throat, associated with a dry swallow. The most helpful diagnostic procedure was careful examination of the hypopharynx and neck and flexible fibre-optic rhinolaryngoscopy. One case was treated with surgery of the neck and larynx to trim the medially projecting superior cornu of the thyroid cartilage. Surgery was successful in eliminating the symptoms.Although an uncommon finding, our experience is that symptoms due to a medially displaced thyroid cornu should be considered in the differential diagnosis as an important and surgically correctable cause of persistent foreign body sensation at the hyoid level in the neck.
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Affiliation(s)
- S K Nadig
- Department of ENT, York District Hospital, York, UK.
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14
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Uppal S, Jose J, Banks P, Mackay E, Coatesworth AP. Cost-effective analysis of conventional and nurse-led clinics for common otological procedures. J Laryngol Otol 2006; 118:189-92. [PMID: 15068514 DOI: 10.1258/002221504322927946] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The need to reduce costs while providing a first-class service has led to the expansion in the role of nurses in recent years. We present results of a comparison of the cost-effectiveness of conventional and nurse-led out-patient ear clinics. Our results indicate that cost-effective health care is a distinct competitive advantage for nurses taking up some roles conventionally performed by doctors. The difference in mean cost of out-patient visit per patient between the two groups is £75.28. This is equivalent to a reduction in cost to the hospital of more than £47000 for the 626 patients seen in a nurse-led ear clinic in a year. The nurse-led service is thus more cost-effective and presents an opportunity by freeing up otolaryngologists’ time to see more complex patients and has the potential for reducing out-patient access time in the NHS.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK.
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15
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Agada FO, Kortequee S, Jenkins CN, Coatesworth AP. What happens to the lateral sinus following thrombosis? A case of failed recanalization. J Laryngol Otol 2006; 118:988-90. [PMID: 15667691 DOI: 10.1258/0022215042790600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Recanalization of the lateral sinus thrombosis is an expected outcome in patients who respond to treatment. We report a case of persistent lateral sinus thrombosis many years after treatment for peri-sinus infection.
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Affiliation(s)
- F O Agada
- Otolaryngology Department, York Hospital, York, UK.
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16
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Abstract
This is the last of the three review articles dealing with thyroid cancer. Over 90% of thyroid cancer is of the differentiated type associated with a very good 10-year disease-free survival rate. In contrast, the rare forms of thyroid cancer which comprise medullary thyroid cancer arising from parafollicluar C cells, Hurthle cell carcinoma, anaplastic carcinoma, thyroid lymphoma and squamous cell carcinoma are typically associated with a poorer survival rate. Management is based upon small retrospective cohort studies.
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Affiliation(s)
- P A Nix
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK
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17
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Abstract
This is the second review article on thyroid cancer dealing with the common differentiated types that comprise 90% of thyroid cancers. Despite clinical management guidelines offered by a number of organisations including the British Association of Otolaryngologists and Head and Neck Surgeon, The British Thyroid Association, The American Association Of Endocrinologists, The American Thyroid Association and the National Cancer Centre Network, debate regarding the management of differentiated thyroid cancer continues. This is because of the absence of good quality research evidence as a consequence of the natural history of this disease.
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Affiliation(s)
- P Nix
- Department of Otolaryngology, Head and Neck Surgery, York, UK
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18
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Abstract
Thyroid cancer is uncommon with an estimated lifetime risk of 0.8% for women and 0.3% for men. The incidence appears to be increasing by 4% per year and is currently the eighth commonest cancer in women. Managing thyroid cancer is challenging, as no prospective randomised trials exist. Most of the information is derived from large patient cohorts in which therapy has not been randomly assigned. This is the first of the three review papers we have written on the management of thyroid cancer.
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Affiliation(s)
- P Nix
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, UK
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19
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Abstract
Cystic lesions of the larynx are most commonly benign. However, we report a case of non-Hodgkin's lymphoma (NHL) of the larynx which presented as a supraglottic cyst. This form of presentation has not been previously described in the medical literature.
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MESH Headings
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Cysts/etiology
- Diagnosis, Differential
- Doxorubicin/administration & dosage
- Humans
- Immunosuppressive Agents/therapeutic use
- Laryngeal Diseases/etiology
- Laryngeal Neoplasms/complications
- Laryngeal Neoplasms/drug therapy
- Lymphatic Metastasis
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/drug therapy
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Male
- Middle Aged
- Prednisone/administration & dosage
- Rituximab
- Tomography, X-Ray Computed
- Vincristine/administration & dosage
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Affiliation(s)
- F O Agada
- Department of Ear, Nose and Throat/Head & Neck Surgery, York Hospital, York, UK.
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20
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Abstract
Otolaryngologic symptoms are common and patients presenting to the otolaryngologist will often be taking drugs for the treatment of unrelated diseases. As a doctor, one must not forget the potential of these drugs to cause otologic side effects and, in some cases, to be the cause of the presenting symptom. We performed a comprehensive search of the British National Formulary and Electronic Medical Compendium websites to classify the otologic side effects caused by drugs. Not all the data were found at both websites. We have compiled all the data together, subclassified them and produced a review of the otologic side effects of drugs, in table form.
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Affiliation(s)
- C A Lee
- Department of Otolaryngology, York Hospital, York, UK.
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21
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Abstract
Spontaneous rupture of the oesophagus is a rare event. Most have been reported in association with oesophageal carcinoma, peptic ulceration and alcohol abuse followed by forceful episode of vomiting. We, however, report a case of spontaneous rupture of the oesophagus in an otherwise healthy individual with no history of alcohol intake, as a consequence of blowing of the nose.
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Affiliation(s)
- F O Agada
- Otolaryngology Department, York Hospital, Wigginton Road, York, UK.
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22
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Abstract
A 26-year-old male presented with sudden right-sided sensorineural hearing loss after injection of heroin into the right neck. The hearing loss was found to be profound with no other associated abnormalities on examination or investigation. There was no change at 3-month follow-up. This was most probably due to arterial injection and is a previously unreported complication of heroin abuse.
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Affiliation(s)
- S Kortequee
- Department of Ear, Nose and Throat/Head and Neck Surgery, York Hospital, York, UK
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23
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Abstract
From ancient times up to the present day many different functions and conditions have been attributed to the uvula, many speculative and some with a more scientific basis. The uvula has been shown to have the ability to produce and secrete large quantities of thin saliva. A common complication of surgery involving removal of the uvula is pharyngeal dryness. We have observed that on phonation and swallowing the uvula swings back and forth in the oropharynx. We present a review of the literature on the uvula and propose a theory that the uvula bastes the throat and thereby helps keep it moist and well lubricated.
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Affiliation(s)
- G W Back
- Department of Otolaryngology/Head and Neck Surgery, York District Hospital, Wigginton Road, York, UK.
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24
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Uppal S, Sharma R, Nadig SK, Back G, England RJA, Coatesworth AP. A blindedin-vitrostudy to compare the efficacy of five topical ear drops in clearing grommets blocked with thick middle ear effusion fluid. Clin Otolaryngol 2005; 30:29-34. [PMID: 15748186 DOI: 10.1111/j.1365-2273.2004.00920.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the efficacy of 5% NaHCO3, 3% H2O2, Sofradex (dexamethasone sodium metasulphobenzoate 0.05%, framycetin sulphate 0.5%, gramicidin 0.005%), 0.33% acetic acid and 0.9% NaCl eardrops in clearing grommets blocked with harvested thick middle ear effusion fluid. STUDY DESIGN A blinded in-vitro study. SETTING District general hospital. PARTICIPANTS A total of 473 grommets were blocked with freshly harvested unpooled thick middle ear effusion fluid obtained from 68 patients. MAIN OUTCOME MEASURES Patency of the grommets before and 7 days after intervention was ascertained by tympanometry and close visual inspection. RESULTS Instillation of eardrops leads to a statistically significant increase in the clearance of grommets as compared with not using any drops (chi2 = 14.3, d.f. = 5, P = 0.006). The numbers needed to treat were 2.8 for NaHCO3, 3.2 for 0.9% NaCl, 3.9 for 0.33% acetic Acid, 4.4 for Sofradex and 9.5 for H2O2 eardrops. Pair-wise comparison was only significant for comparison between 5% NaHCO3 and 3% H2O2 eardrops (Bonferroni corrected P = 0.01, odds ratio = 4.3, CI = 1.9-9.9). CONCLUSIONS Use of eardrops leads to a clinically and statistically significant increase in the clearance of blocked grommets. Of the five drops used, 5% NaHCO3 was the most efficacious and 3% H2O2 the least efficacious. Limitations of this in-vitro study are recognized and a prospective in-vivo double blind randomized controlled trial is planned.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK.
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25
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Abstract
The objective of this blinded randomized trial was to compare five sets of bipolar forceps, both single use and reusable, and discuss their potential role in postoperative complications. An animal tissue experiment was set up with standardized parameters. Results indicate larger tips give larger burns. We also found that some forceps gave suboptimal burns.
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Affiliation(s)
- S K Nadig
- Department of ENT, York District Hospital, Wigginton Road, York, UK.
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26
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Uppal S, Nadig S, Smith L, Coatesworth AP. A cost-effectiveness analysis of conventional and nurse-led telephone follow-up after nasal septal surgery. Ann R Coll Surg Engl 2004; 86:243-6. [PMID: 15239863 PMCID: PMC1964214 DOI: 10.1308/147870804515] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The need to bring down costs while maintaining a high standard of care has led to the expansion in the role of nurses in recent years. METHODS We present results of cost-effectiveness analysis of conventional and nurse-led telephone follow-up after nasal septal surgery. RESULTS AND CONCLUSIONS Our results indicate that the substitution of nurse-led telephone follow-up for conventional out-patient follow-up has the potential for substantial cost reduction and decreased out-patient access times in the NHS.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, Wigginton, York YO31 8HE, UK
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27
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Uppal S, Nadig S, Jones C, Nicolaides AR, Coatesworth AP. A prospective single-blind randomized-controlled trial comparing two surgical techniques for the treatment of snoring: laser palatoplasty versus uvulectomy with punctate palatal diathermy. ACTA ACUST UNITED AC 2004; 29:254-63. [PMID: 15142071 DOI: 10.1111/j.1365-2273.2004.00810.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of this study was to compare laser palatoplasty with uvulectomy with punctate palatal diathermy as treatment modalities for snoring. The study design was a prospective, single-blind, randomized-controlled trial. Eighty-three patients entered the trial. After a mean follow-up period of more than 18 months there was no statistically significant difference between the two groups regarding the patient perception of benefit from surgery or the subjective improvement in snoring. However, there was a statistically significant difference in the degree of pain in the immediate postoperative period (mean difference = 22.14, 95% CI = 7.98-36.31, P = 0.003), with the pain being worse in the laser palatoplasty group. Relative risk of complications for laser palatoplasty was 1.42 (95% CI = 0.93-2.17). The snoring scores and Glasgow Benefit Inventory scores decreased with time in both the groups but there was no statistically significant difference between the two groups.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK.
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28
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Abstract
We describe a rare case of benign inflammatory pseudotumour of the parotid gland. The literature concerning this condition is discussed.
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Affiliation(s)
- M W Mielcarek
- Department of Otolaryngology, York District Hospital, Wigginton Road, York, UK
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29
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Abstract
We present the management of a patient with nasopharyngeal carcinoma with a history of recurrent syncopal attacks diagnosed as malignant vasovagal syndrome. We discuss clinical presentation as well as the resolution of disease symptoms. The importance of metastatic nasopharyngeal malignancy in relation to syncope is discussed.
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Affiliation(s)
- G K Kala
- Department of Otolaryngology/Head and Neck Surgery, York Hospital, Wigginton Road, York, UK
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30
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Uppal S, Nadig S, Mielcarek MW, Smith L, Jose J, Coatesworth AP. Patient satisfaction with conventional and nurse-led telephone follow-up after nasal septal surgery. Int J Clin Pract 2003; 57:835-9. [PMID: 14686576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
The need to bring down costs while maintaining a high standard of care has led to the expansion in the role of nurses in recent years. We present results of an audit of patient satisfaction with conventional and nurse-led telephone follow-up after nasal septal surgery. Our results indicate that patient satisfaction with nurse-led telephone follow-up is significantly higher than conventional follow-up (p=0.001, two-tailed). More patients in the conventional follow-up group felt that a follow-up appointment with an ENT doctor was essential compared with the patients in the nurse-led telephone follow-up group (p<0.001, two-tailed). We conclude that nurse-led telephone follow-up avoids unnecessary outpatient appointments, while identifying patients who require further care. It makes more appointment slots available for patients with pressing clinical problems and has the potential to reduce outpatient access times in the NHS.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK
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31
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Uppal S, Coatesworth AP. Neurofibromatosis type 2. Int J Clin Pract 2003; 57:698-703. [PMID: 14627181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Neurofibromatosis type 2 (NF2) is often not recognised as a distinct entity from peripheral neurofibromatosis. NF2 is a predominantly intracranial condition whose hallmark is bilateral vestibular schwannomas. NF2 results from a mutation in the gene named merlin, located on chromosome 22. The disease has a variable presentation, with the severe subtype having an early and rapid progression and the milder type having a later onset and a less aggressive course. The diagnosis and management of these patients present a unique challenge. There are also implications for the family members as half the cases are inherited. We discuss the genetic characteristics, clinical presentation, natural history, diagnostic criteria, investigations, screening and management of this condition.
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Affiliation(s)
- S Uppal
- Department of Otolaryngology, Head and Neck Surgery, York Hospital, York, UK
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32
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Nix PA, Coatesworth AP. Carotid artery invasion by squamous cell carcinoma of the upper aerodigestive tract: the predictive value of CT imaging. Int J Clin Pract 2003; 57:628-30. [PMID: 14529067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Abstract
Carotid artery invasion by squamous cell carcinoma of the upper aerodigestive tract is a poor prognostic indicator and a relative indicator of tumour inoperability. A number of imaging modalities are available for detecting such invasion, but, because of its availability, computerised tomography (CT) is the usual modality. We have analysed the CT scans of 196 patients referred to the department with an upper aerodigestive tract squamous cell carcinoma. Comparing the scans with the operative findings indicates that CT scans significantly overestimate carotid artery invasion.
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Affiliation(s)
- P A Nix
- ENT SpR Yorkshire Region, Academic Surgical Unit, Research and Development Building, Castle Hill Hospital, Cottingham HU16 5JQ, UK
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33
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Stark RD, Coatesworth AP, Tucker AG. Management of life-threatening epistaxis in a Jehovah's Witness. Int J Clin Pract 2003; 57:60-1. [PMID: 12587946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023] Open
Abstract
The religious beliefs of Jehovah's Witnesses forbid them to receive blood or blood products. We report a case of life-threatening epistaxis in a Jehovah's Witness, causing severe anaemia (Hb 2.7 g/dl). The successful management of this case and literature relating to this are discussed.
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Affiliation(s)
- R D Stark
- Department of Otolaryngology, Bradford Royal Infirmary, Bradford, UK
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Coatesworth AP, MacLennan K. Cervical metastasis in papillary carcinoma of the thyroid: a histopathological study. Int J Clin Pract 2002; 56:241-2. [PMID: 12074202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The tendency of well differentiated thyroid carcinoma to remain localised, and the slow progression of these tumours, have supported the belief that this disease behaves as a low grade malignancy. However, with differentiated carcinomas of the thyroid the incidence of nodal metastasis is highest in the papillary subgroup, and the importance of cervical metastases is being increasingly recognised. We have performed and prospectively analysed 17 neck dissections in 13 patients with clinically N+ve necks and papillary carcinoma of the thyroid. In all 17 neck dissections, metastatic deposits of papillary carcinoma of the thyroid were seen, with metastases found in all levels. Our findings of positive lymph nodes in all levels of the neck, with no predictable pattern of spread, and skip metastases, support an aggressive surgical approach to the treatment of cervical metastatic papillary carcinoma of the thyroid.
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Affiliation(s)
- A P Coatesworth
- Department of Otolaryngology, Head and Neck Surgery, Leeds General Infirmary
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Abstract
For patients with head and neck squamous cell carcinoma the cause of death is not well described in world literature. We report data on 106 patients diagnosed with head and neck squamous cell carcinoma who subsequently died. The literature related to this topic is discussed, and recommendations are made for data collection.
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Affiliation(s)
- A P Coatesworth
- Department of Otolaryngology, Head and Neck Surgery, Leeds General Infirmary, Leeds, UK.
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36
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Abstract
The association of Kallmann's syndrome with conductive hearing loss has not previously been described. We report the findings at tympanotomy in three ears of patients with Kallmann's syndrome and conductive deafness. The literature related to this topic is reviewed, and the treatment of these patients is discussed.
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Affiliation(s)
- A P Coatesworth
- Department of Otolaryngology, Head and Neck Surgery, Leeds General Infirmary, Leeds, UK.
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Coatesworth AP, Addis RJ, Beverley DW. Ear nose and throat diseases in the Bedouin of the South Sinai Desert: a cross-sectional survey and discussion of healthcare needs. J Laryngol Otol 2002; 116:83-6. [PMID: 11827577 DOI: 10.1258/0022215021909827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the summer of 2000, a team of medical and affiliated workers visited the South Sinai Desert to assess the medical problems and needs of the Bedouin population. This paper reports on the ENT diseases of this population, and discusses their healthcare needs.
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Affiliation(s)
- A P Coatesworth
- Department of Otolaryngology Head and Neck Surgery, Leeds General Infirmary, Leeds, UK.
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Abstract
A review of the literature reveals only 12 reported cases of laryngeal gout. We describe three further cases of laryngeal gout, the largest series ever published. The first case is previously undescribed acute gouty cricoarytenoiditis resulting in acute airway embarrassment requiring tracheotomy, and then we describe two cases of chronic tophaceous involvement of the thyroid lamina with computed tomography (CT) images of this process. The paucity of literature on this subject may not only be due to rarity but also lack of clinical awareness. Gouty involvement of the larynx must be considered in any patient with a history of gout who presents with hoarseness, odynophagia, dysphagia, stridor or neck lump. Acute airway compromise may require tracheotomy, whereas chronic airway problems may necessitate endoscopic tophi removal, lateralization procedures or even permanent tracheostomy.
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Affiliation(s)
- A Tsikoudas
- Department of Otolaryngology, Hull Royal Infirmary, Hull, UK.
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Coatesworth AP. Use of a customised endotracheal tube for tracheostomy in the large neck. Int J Clin Pract 2002; 56:52. [PMID: 11831836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Patients with huge necks who require a tracheostomy pose particular problems. This paper describes a technique to customise a standard endotracheal tube to make a long tracheostomy tube. This can be used as a short-term emergency airway. It is recommended because it is cheap, simple, safe and potentially life saving.
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Affiliation(s)
- A P Coatesworth
- Department of Otolaryngology, Head and Neck Surgery, Leeds General Infirmary, UK
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Coatesworth AP. Trilobed pharyngeal diverticulum. Int J Clin Pract 2001; 55:491. [PMID: 11594264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
A previously undescribed case of a trilobed pharyngeal diverticulum is reported. Its presentation, radiological features and treatment are discussed.
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Affiliation(s)
- A P Coatesworth
- Department of Otolaryngology Head and Neck Surgery, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
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Coatesworth AP. Assessment and treatment of dizziness. J Neurol Neurosurg Psychiatry 2000; 69:706. [PMID: 11184241 PMCID: PMC1763384 DOI: 10.1136/jnnp.69.5.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Coatesworth AP, Darnton SJ, Green RM, Cayton RM, Antonakopoulos GN. A case of systemic pseudo-pseudoxanthoma elasticum with diverse symptomatology caused by long-term penicillamine use. J Clin Pathol 1998; 51:169-71. [PMID: 9602696 PMCID: PMC500517 DOI: 10.1136/jcp.51.2.169] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A 47 year old man presented with a two year history of increasing cervical dysphagia, dyspnoea, and cutaneous signs. He had been diagnosed 27 years previously with Wilson's disease and was treated with penicillamine (1.5 g daily). Systemic abnormality of elastic fibres was confirmed by light and electron microscopy following biopsy of skin, lung, oesophageal muscle, gum, pharyngeal tissue, and cervical connective tissue. Dysphagia was relieved by cricopharyngeal myotomy. Substitution of trientene dihydrochloride for penicillamine relieved cutaneous and systemic manifestations. This is possibly the first case demonstrating an association between prolonged penicillamine use and biopsy proved systemic pseudo-pseudoxanthoma elasticum. The presenting symptoms may have resulted from the abnormal numbers and properties of elastic fibres, and the changes were caused by penicillamine use, rather than by idiopathic, inherited pseudoxanthoma elasticum.
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Affiliation(s)
- A P Coatesworth
- Department of Thoracic Surgery, Birmingham Heartlands Hospital, UK
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Abstract
The first reported case of liposarcoma of the temporal bone is presented. Its association with previous irradiation for benign parotid disease is discussed.
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Affiliation(s)
- G S Barr
- Department of Otolaryngology, Queen Elizabeth Hospital, Birmingham
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