Excess vitamin D and the ear.
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Bone Density Conservation Agents↗
Biomedical subjects
B J Bingham
Publications and source records attributed to B J Bingham.
Can nasal endoscopy be used to predict residual symptoms after adenoidectomy for nasal obstruction?
BACKGROUND: the efficacy of adenoidectomy in relieving nasal symptoms has been questioned. Although enlarged adenoids are often blamed for nasal obstruction, other causes can be missed if examination is not thorough. We suggest that endoscopy at the time of adenoidectomy may be useful to confirm large adenoids and exclude other causes, and the findings may help predict residual symptoms 2 years after adenoidectomy. METHOD: a prospective study of a consecutive series of children undergoing adenoidectomy for nasal obstruction was performed. All underwent endoscopy with a 4-mm rigid endoscope without decongestants under GA immediately prior to adenoidectomy. Two years later a postal symptom questionnaire was sent, with telephone follow up for non-responders. The findings on endoscopy were compared with residual symptoms at 2 years. RESULTS: Forty-eight children aged 2-9 (mean 4) years were enrolled, 26 of them female. At 2 years follow up, data were available for 34 children (71%). Complete obstruction of the posterior choanae of the nose by adenoids was seen in 21 (62%). Additional findings (e.g. septal deviation, hypertrophic mucosa on the turbinates) were present in 22 (65%). Of them 9 (26%) had residual nasal symptoms. Of the children with less than occlusive adenoids, six (50%) out of 12 had residual symptoms, compared with three (14%) out of 21 with occlusive adenoids (chi(2)=4.91, P<0.05). Although residual symptoms were more common in those with additional findings on the original endoscopy (32 vs. 17%), this did not reach statistical significance. CONCLUSIONS: residual nasal symptoms are common when children are followed up in the medium term. The findings on endoscopy may predict the success of adenoidectomy in relieving the symptoms, and may help to guide further treatment.
Adenoidectomy↗
Endoscopy in the assessment of children with nasal obstruction.
Nasal obstruction is common in children, and is often attributed to adenoid enlargement. This prospective study was performed to determine whether routine nasal endoscopy is of value for children undergoing surgery for nasal obstruction. Forty-eight children aged two to nine years undergoing adenoidectomy, and six normal controls, were examined under general anaesthesia with a 4 mm rigid endoscope. A video of the endoscopy was subsequently assessed independently by an observer blinded to the original findings and the presence of nasal symptoms. The endoscopist and independent assessor were in agreement regarding 86 per cent of the findings. Three quarters of the children had abnormalities on endoscopy in addition to enlarged adenoids, and in 23 per cent these were potentially of major clinical significance (unsuspected foreign body, gross septal deviation, gross hypertrophy of the turbinates). Endoscopy produced no post-operative complications and was possible in children as young as two years of age, without decongestants. Nasal endoscopy is a safe, objective and useful means of identifying potentially significant abnormalities in children with nasal obstruction.
Adenoidectomy↗
Laryngeal involvement by cutaneous lymphoma.
Laryngeal involvement by cutaneous lymphoma is rare; it may be isolated or part of systemic spread. We report a case of cutaneous T-cell lymphoma with isolated extracutaneous spread to the larynx, confirmed by the polymerase chain reaction in addition to histology. Awareness of this association may allow early recognition of symptoms heralding laryngeal embarrassment.
Aged↗
Do sports nasal strips improve nasal airflow? A preliminary report.
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Adolescent↗
Torsion of the palatine tonsil.
Torsion of a pedunculated part of the palatine tonsil is extremely rare. This paper discusses the clinical presentation, differential diagnosis, treatment of such a case and reviews the existing literature.
Child↗
Analysis of CT scanning referrals for chronic rhinosinusitis.
The principal role of computed tomography (CT) scanning in rhinosinusitis is as a planning investigation for patients requiring functional endoscopic sinus surgery (FESS). The pre-operative scan is used to highlight any potential surgical hazards, and to delineate the extent of disease reducing unnecessary intervention in disease-free areas. It is inappropriate for CT to be used purely as a diagnostic investigation for chronic rhinosinusitis. As concern has been expressed over the steady rise in the referrals for CT of the sinuses, we conducted a retrospective review of all patients having these scans at two CT scanner sites in Scotland during 1993. Of the 162 scans performed for rhinosinusitis, 58 patients (36 per cent) had not had nasendoscopy performed or had a trial of medical treatment. Subsequently, only 61 patients (38 per cent) went on to FESS. The inappropriate use of CT for these patients can be reduced by insisting that nasendoscopy is performed prior to scanning. Furthermore, radiologists and surgeons should audit the number of patients not having FESS after scanning.
Chronic Disease↗
A pilot study of the holmium YAG laser in nasal turbinate and tonsil surgery.
A pilot study of the holmium YAG laser (a solid-state pulsed laser, wavelength 2.1 mum) was performed for tonsillectomy and nasal turbinate surgery. In the nose, intraoperative bleeding was negligible, facilitating an excellent view of the operative field and avoiding the need for postoperative nasal packs. There was no occurrence either of primary or secondary hemorrhage. Some intranasal crusts separated with no difficulty between 3 and 6 weeks. There was no significant delayed tissue destruction. Tonsillectomy was almost bloodless. There was some minor difficulty in mobilizing the upper tonsillar pole. Postoperative pain was no worse than routine tonsillectomy pain and may have been less than would be expected. The tonsil beds healed within two weeks. The comparable roles of the CO 2, the neodymium YAG, and the KTP/532 laser for nasal and oropharyngeal surgery are discussed. These preliminary results suggest a potential role for the holmium YAG laser in nasal turbinate and tonsillar surgery and the need for further evaluation.
Adolescent↗
A comparison of performance of Shepard and Sheehy collar button ventilation tubes.
This study was designed to confirm the longer in situ life of the Sheehy collar button compared with the Shepard tube and to assess the complication rates associated with the two tubes. Cases of bilateral otitis media with effusion had a Shepard tube inserted in one ear and a Sheehy contralaterally. The insertion position was allocated randomly. The patients were then assessed at three-monthly intervals for two years. In 71 per cent of those in whom at least one tube had extruded, the Sheehy remained in situ longer. The antero-inferior tube remained longer than the postero-inferior whichever type was used. There was no significant difference between complication rates, or recurrence rates of middle ear effusion after tube extrusion, for the two types. We conclude that use of a Sheehy rather than a Shepard tube carries no increased risk of complications and the patient may require further surgery less often in total.
Adolescent↗
Aspirating middle ear effusions when inserting ventilation tubes: does it influence post-operative otorrhoea, tube obstruction or the development of tympanosclerosis?
This prospective study examined the influence of aspirating middle ear effusions, immediately prior to ventilation tube insertion, upon the subsequent development of otorrhoea and tympanosclerosis. 50 children were studied and aspiration of effusions did not influence the incidence of purulent otorrhoea or ventilation tube obstruction within 1 month of surgery. The development of tympanosclerosis did not correlate with effusion aspiration, but in those ears which had an effusion aspirated there was a relation between operative bleeding and the development of tympanosclerosis.
Child↗
Granular cell tumour of the larynx.
A granular cell tumour may present as clinically innocuous lesions on the vocal cords and the diagnosis is usually made by histopathology. However, the granular cells characteristic of this tumour may not be obvious and accompanying epithelial hyperplasia may be interpreted by the pathologist as invasive squamous cell carcinoma. Good communication between pathologist and surgeon is required to ensure that clinically benign lesions on the vocal cords are not misdiagnosed. The diagnosis of granular cell tumour can be confirmed by immunocytochemical staining for S100 antigen.
Adult↗
Episodic macroglossia in Down's syndrome.
We report a unique case of recurrent gross enlargement of the tongue associated with lymphangiectasia and tongue protrusion in an adult male with Down's syndrome. There were three episodes of acute macroglossia with no clinically identifiable cause. Spontaneous resolution always occurred after five to six days. Histological examination of the tongue, at post mortem, revealed a primary lesion of the lingual lymphatics. The possible mechanisms of acute macroglossia and the surgical techniques which could have been used to reduce the tongue bulk are discussed.
Acute Disease↗
Sublabial rhinotomy with septal transfixion as an approach to the nasal fossa, paranasal sinuses and nasopharynx.
A sublabial incision with septal transfixion and mid-face degloving is described as an approach to the nasal cavity, paranasal sinuses and nasopharynx. A brief history of the development of the technique is given. The results of nine cases are presented. These cases have had good tumour clearance, excellent cosmetic results and the minimum of complications. The sublabial approach is most useful in children and women, particularly those with intermediate grade tumours. The advantages of the approach compared to the lateral rhinotomy incision include: superior access to the floor of the nose, inferior turbinate and anterior nasal septum; access to both sides of the nasal septum and the absence of a facial scar. The limitations of the sublabial technique are the poor access to frontal sinus and the cribriform plate.
Humans↗
The histological appearance of the tympanic edge in contact with an indwelling ventilation tube (grommet).
This study describes the histological features of the tympanic membrane which has been in contact with an indwelling ventilation tube and considers the factors of tube type, time in situ, persistent aural discharge and the comparison to perforations residual to grommet extrusion. The specimens were obtained at the time of operative removal of a grommet. The 21 margins examined were characteristically hyperplastic and hyperkeratotic with a prominent granular layer. The squamous epithelium was from 8 to 25 cell layers thick and the connective tissue core was increased. Chronic inflammation was common. Features of chronic otitis media (respiratory epithelium, goblet cells and glandular tissue) were found in 7 margins (2 perforations and 5 grommet specimens). A theory of grommet extrusion is presented in this paper in the light of the histological findings.
Adolescent↗
Tympanic membrane perforation following the removal of ventilation tubes in the presence of persistent aural discharge.
This study considers the effect of the removal of a ventilation tube from the tympanic membrane of an ear which has been affected with persistent mucopurulent discharge for at least 3 months. The records of 332 patients were reviewed. Thirty-three patients with 34 ears satisfied the entry criteria. Tube removal cured 27 out of 34 ears (79%) of aural discharge within 1 month. The tympanic membrane healing rates were: at 1 month, 14 (41%); at 3 months, 23 (68%); at 6 months, 24 (71%); and at 1 year, 28 (82%). A table is presented comparing perforation rates from different ventilation tube studies.
Adolescent↗
Water contamination and swimming with the open mastoid cavity.
The aim of this study was to assess whether patients with open mastoid cavities should be advised to avoid water contaminating the ear in order to avoid aural discharge. A detailed history and clinical examination was performed on 53 patients with a unilateral modified radical mastoid cavity of more than 5 years duration. The results showed that it is possible to identify reliably the well-designed trouble-free cavity by the features of its skin lining and the ability to visualize the entire cavity through a size 4 Siegle speculum. A patient with this form of cavity very rarely develops aural discharge following water exposure and need not protect the ear during washing but should do so when swimming because of caloric effects.
Adult↗
The swallowed foreign body: is it in the nasopharynx?
Children with a history of a suspected swallowed radio-opaque foreign body should undergo radiographic examination of the nasopharynx even in the absence of symptoms and signs. Failure to identify and remove an object at this site can result in potentially fatal consequences.
Child↗