A review of the current management of impacted foreign bodies in the oesophagus in adults

Patients with acute oesophageal obstruction, either due to a foreign body or food bolus, present to any of the specialties of Otorhinolaryngology, General Surgery, Cardiothoracic Surgery or Gastroenterology. To review current routine management of this condition, we conducted a postal survey of all the consultants in the aforementioned specialties in the South Thames region. The aims of the survey were to assess current practice and to produce a standardized management plan for these patients.

Epistaxis and oral anticoagulant therapy

Epistaxis in the anticoagulated patient poses a complicated management problem, which requires interdisciplinary collaboration. The aetiology of the majority of cases of epistaxis remains idiopathic, but an ageing population and the prevalence of ischaemic heart disease and peripheral vascular disease has meant that there are increasing numbers of patients on long term oral anticoagulant therapy. This has led to a concomitant increase in the incidence of complications experienced. We have reviewed the available relevant literature and guidelines in the current management practice in this scenario. In light of this, we propose a more standardised algorithm for the management of epistaxis in this challenging group of patients.

Hairy polyp of the oropharynx: an unusual cause of intermittent neonatal airway obstruction

Oropharyngeal hairy polyps are rare benign congenital tumours that usually present at birth or shortly afterwards with acute upper airway obstruction or feeding difficulties. We describe a case of intermittent airway obstruction in a neonate caused by a mobile hairy polyp of the tonsil. This rare benign lesion proved difficult to diagnose because of its tendency to prolapse into the nasopharynx.

Odontogenic keratocyst: an unusual cause of unilateral nasal swelling

The odontogenic keratocyst is the least common of all odontogenic cysts which usually presents to the maxillofacial surgeon. An unusual case is described which presented to the ENT department with a rapidly enlarging unilateral intranasal mass. The clinical and radiological features of this lesion are presented and attention is drawn to the need for aggressive surgical excision because of its high recurrence rate.

Foreign bodies in the throat: a prospective study of 388 cases

We present the results of a prospective study of 388 patients presenting with a history of swallowing a foreign body. We indicate whether the patients' symptoms and signs were associated with a retained foreign body. While tenderness on palpation was an unreliable sign, pooling at indirect laryngoscopy invariably predicted a retained object. In many patients, initial careful examination of the oropharynx by casualty officers would have shown a retained fishbone in the tonsil or tongue and would have resulted in 16 per cent fewer radiographs and 17 per cent fewer referrals to the ENT department. Radiography only improved management in a small minority and 35 per cent of films were interpreted incorrectly by casualty officers. A follow-up barium swallow disclosed a pathological lesion in a significant proportion of patients with bolus obstruction, whether or not this was passed spontaneously.

Efficacy of oral oxpentifylline in the management of idiopathic tinnitus

A prospective single-blind, placebo-controlled trial was effected in 30 patients presenting to an out-patient clinic complaining principally of tinnitus. Over a 6-week period, the subjects were assessed by routine audiometry and subjective reporting of change in their symptoms. A treatment group received the xanthine derivative, oxpentifylline (Hoechst UK), while a control group received identically presented inactive placebo. There was no significant difference between the placebo and treatment groups for any of the parameters measured, and, therefore, oxpentifylline cannot be recommended in the management of idiopathic tinnitus.

Kikuchi's--a new cause of cervical lymphadenopathy

A case of Kikuchi's presenting in a young West Indian lady is recorded which typifies this rare condition. This histological features have been discussed and differential diagnosis outlined.