Laryngeal Chondrosarcoma: A rare cause of critical upper airway obstruction

Laryngeal cancers are rare, encompassing around one percent of all cancers. Suspicion should be raised if a patient presents with classical signs and symptoms; i.e. dysphonia, inspiratory stridor, dysphagia, odynophagia, neck mass, or persistent cough. Laryngeal chondrosarcoma is a rare form of laryngeal cancer, the diagnosis of which can be difficult. The case in question describes an unusual presentation of one such case, and its subsequent investigation, management and outcome.

Paediatric tonsillotomy--an Irish perspective on potential evolving indications

Tonsillotomy is the preferred treatment of some otolaryngologists for younger patients (under 3 years) with low body weight (under 15 kgs) and a history of obstructive sleep apnoea. The use of the technique in the same patient cohort for recurrent tonsillitis remains controversial. The aim of this study was to evaluate the indications and outcomes of paediatric patients undergoing tonsillotomy (with or without adenoidectomy) at a paediatric ENT centre in Ireland. Patients were identified from a prospectively maintained database and chart review was completed. A total of 23 patients were identified who underwent tonsillotomy. The commonest indication was Obstructive Sleep Apnoea (OSA) in 15 patients (65%). Outcomes following tonsillotomy compared favourably with traditional tonsillectomy. No intra-operative or post-operative complications were recorded (0%). No patients required readmission or later tonsillectomy (0%). At follow-up 19/23 patients with OSA (82.6%) had complete symptom resolution. Tonsillotomy appears to represent a safe, effective treatment option in the paediatric population, however, its role in recurrent tonsillitis remains controversial.

A case of quinsy following high-pressure water jet injury

High-pressure water injuries of the oropharynx are uncommon but can cause significant injury and airway compromise when they occur. A small number of cases of high-pressure water injury of the oropharynx have been presented in the literature, detailing a range of effects and outcomes. We describe the first reported case of high-pressure water injury of the oropharynx associated with peritonsillar abscess (quinsy) requiring surgical drainage.

General practitioner ENT referral audit

BACKGROUND

During 2009, there were 3.3 million outpatient attendances at outpatient clinics across Ireland. Up to 20 % of these are directed towards ENT services.

AIMS

To determine the compliance rate of general practitioners with the ICGP referral guidelines.

METHODS

One-hundred referrals received were compared to the ICGP standardised form and graded accordingly. Each referral letter was graded to a maximum of 37 points.

RESULTS

The average score recorded for referrals was 16/37. The referrer detail section scored the highest with a mean of 75.42 % (paediatric referrals) and 72.9 % (adult referrals). The clinical information provided demonstrated compliance rates of 34 % (paediatrics) and 35 % (adults). In total, only 32 letters made any reference to findings on examination. Both paediatric and adult referrals scored an average of 42 % when patients' details are considered.

CONCLUSION

This study demonstrates poor compliance rates with the introduced ICGP standardised referral form, which has implications for the accurate grading of referral letters received.

Alternatives to the impact factor

OBJECTIVE

To explore alternative bibliometric markers to the well-established journal impact factor. The bibliometric evolution of a leading ENT journal over a six year period is discussed with critical analysis of a predetermined set of bibliometric alternatives to the journal impact factor.

DESIGN

Retrospective review of the bibliometric performance of Clinical Otolaryngology over a six year period.

RESULTS

The results of the study reveal that Clinical Otolaryngology has made steady bibliometric progress when the impact factor (IF) is considered with a gradual increase in impact factor from 1.098 in 2006 to a peak of 2.393 in 2011. Self-citation rates reported by the Journal Citation Report (JCR) demonstrated a significant decline during 2007 with a reported self-citation rate of 0%. The SCImago Journal Rank (SJR) database however recorded a self-citation rate of 67. Independent evaluation demonstrated a 56 self-citations during this period. The percentage of review articles published remained stable during the period in question. A lagged association between the number of review manuscripts and the IF failed to demonstrate any significant correlation (r = -0.19). Comparison between the IF and the Eigen factor (EF) as well as the SJR yielded negative correlation (r = -0.46) and (r = -0.35) respectively. The Article Influence score (AIS) and Source Normalised Impact per Paper (SNIP) were the only bibliometric alternatives to demonstrate a positive correlation when compared to the IF (r = 0.94) and (r = 0.66) respectively.

CONCLUSIONS

The necessity of bibliometric markers cannot be called into question however the most widely employed of these, the journal impact factor has come under increased scrutiny of late. Despite some of the advantages offered by novel bibliometric markers, these do not necessarily compare favourably to the IF with regards to bibliometric performance. The only two markers to demonstrate a positive correlation when compared to the IF were the AI score and SNIP which would suggest that these are potential alternatives to the IF and have the added advantage that they are open access.

The role of pectoralis major myofascial flap in salvage laryngectomy: a single surgeon experience

CONCLUSIONS

These results support the use of a pectoralis major myofascial flap (PMMF) in patients undergoing salvage surgery.

BACKGROUND

Pharyngocutaneous fistula (PCF) is the most common major complication following laryngectomy. Preceding chemoradiotherapy increases the incidence and severity of PCF formation. The aim of this study was to determine whether the use of a PMMF reduces the incidence and severity of PCF formation in patients undergoing salvage surgery.

METHODS

This was a retrospective cohort analysis.

RESULTS

A total of 33 patients were identified, including 10 patients who underwent salvage surgery after chemoradiotherapy. In all, 80% of salvage surgery patients underwent PMMF reinforcement of the pharyngeal closure. A PCF rate of 50% was recorded for salvage surgery patients without PMMF reinforcement. Identical PCF rates (25%) were recorded for patients who underwent primary total laryngectomy and salvage surgery patients treated with PMMF reinforcement. Mean duration to fistula closure was 57.16 days in the primary laryngectomy group compared with 20.5 days in salvage surgery patients with PMMF reinforcement.