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D A Bowdler

Publications and source records attributed to D A Bowdler.

At least 19 recordsLinked to original sources
PubMed2007

A review of retraction pockets: past, present and future management.

Retraction pockets can lead to hearing loss and cholesteatoma. Distinguishing stable from progressive disease is challenging to any otologist. The management of retraction pockets is a contentious issue with present treatment options often plagued with recurrence. The purpose of this article is to summarize recent developments in the aetiology of retraction pockets of the pars tensa, its diagnostic and management problems and to define possible future therapeutic options.

Adult↗
PubMed2005

Diagnostic tools in pseudohypacusis in children.

Pseudohypacusis is the term used for a non-organic or functional hearing loss. The mainstay of diagnosis is a lack of consistency in audiological testing. It is usually easier to diagnose in children than in adults, as children are less able to reproduce consistently erroneous results on repeated testing. Nevertheless, the diagnosis is often missed in children, probably due to a lack of awareness of the condition. In a previous study from our department, we highlighted the usefulness of speech audiometry in establishing the diagnosis. However, with the advent of otoacoustic emissions testing, we have changed the emphasis of our testing protocol. Using otoacoustic emissions, the diagnosis of pseudohypacusis can be established quickly and easily.

Adolescent↗
PubMed2003

Use of laser, otoendoscopy and facial nerve monitoring in otological surgery: United Kingdom survey.

Newer surgical tools, which have been widely accepted as important adjuncts in otological surgery, include the laser, otoendoscopy and facial nerve monitoring. A confidential postal questionnaire survey was carried out to evaluate the usage of these newer techniques among the Consultant members of the British Association of Otorhinolaryngology-Head and Neck Surgery. Our study revealed that the usage of otoendoscopy, laser and/or facial nerve monitoring is not as widespread as might be thought among otological surgeons in the United Kingdom.

Endoscopy↗
PubMed2002

A rare case of a pedunculated lipoma in the pharynx.

While lipomas on the trunk and limbs are common, they are rare in the upper aerodigestive tract. A case is reported of an 18 cm long pedunculated lipoma arising from the hypopharynx in a 73 year old man. The tumour was asymptomatic until it appeared in the mouth of the patient after a coughing episode.

Aged↗
PubMed2001

Extraluminal migration of a coin in the oesophagus of a child misdiagnosed as asthma.

Ingestion of a foreign body, the commonest being a coin, is a common problem in children. In most cases the coin will pass uneventfully through the gastrointestinal tract. However, on rare occasions it may become lodged in the oesophagus with subsequent extraluminal migration with the potential for serious complications such as vascular fistula or chronic suppurative infection. A case is presented of extraluminal migration of a coin in the oesophageal associated with abscess formation in a 15 month old boy. This case is particularly important because the presenting symptom of wheezing led to the erroneous diagnosis of asthma, which resulted in a three month delay in investigation and treatment. In addition, it raises the issue of whether to perform chest radiography on newly diagnosed asthmatic patients to rule out the presence of a foreign body and thereby prevent serious complications.

Abscess↗
PubMed2000

CT scanning in "second look" combined approach tympanoplasty.

One of the main disadvantages of intact canal wall mastoid surgery for cholesteatoma is the necessity of the "second look". The morbidity of a second procedure can be reduced, however, with the aid of a rigid endoscope. Fifty-five consecutive patients undergoing a re-exploration were included in this study. Prior to surgery computerized tomography (CT) was performed in order to assess both the anatomy and degree of pneumatisation of the middle ear cavity and mastoid bowl. The operative findings at the time of the "second look" were correlated with the pre-operative scans. An otoendoscopic approach was possible in all cases. In the diagnosis of residual or recurrent disease, the CT scan had a sensitivity of 43.8%. The specificity of the CT scan was 51.3%. The explanation for these findings is that it is impossible to differentiate between recurrence, scar tissue or inflammation on CT images in patients who have undergone previous mastoid surgery.

Adolescent↗
PubMed1999

The surgical management of the pars tensa retraction pocket in the child--results following simple excision and ventilation tube insertion.

Retraction pockets of the pars tensa formed due to poor mesotympanic ventilation can result in chronic infection, ossicular damage and even acquired cholesteatoma. A diversity in opinion exists as to the best surgical treatment of an established retraction pocket. This paper presents a consecutive prospective series of 39 ears managed over the last 4 years by means of simple excision and insertion of a middle ear ventilation tube. The retraction pockets were graded according to Sade's 1979 classification. There were 23 grade II and sixteen grade III retractions. All 39 pockets were successfully excised. Thirty-four of the perforations healed, with the remaining five failing to heal at the time of analysis. In 13 cases the pockets recurred, but in five of these cases the recurrence is minimal and has required no further surgical intervention. Of the eight remaining significant recurrences, four have undergone a repeat procedure with no further recurrence in three cases. Following initial surgery, 67% of the ears operated upon had either minimal or no recurrence. Following further surgery this figure increased to 75%. The air conduction threshold improved by an average of thirteen decibels in those ears that healed with no recurrence.

Adolescent↗
PubMed1999

An assessment of the value of the preoperative computed tomography scans prior to otoendoscopic 'second look' in intact canal wall mastoid surgery.

'Second look' surgery following primary intact canal wall mastoid surgery for cholesteatoma is considered mandatory for most cases in modern otological practice. The morbidity of the second look can be reduced by the use of the rigid otoendoscope. Forty-three patients undergoing 'second look' surgery were studied with an average age of 24.7 years. Prior to surgery a computed tomography (CT) scan was performed to assess the anatomy and pneumatisation of the cavity. The mean interval between primary and secondary surgery was 16 months and in all cases CT scans were performed within 6 months of 'second look' surgery. The presence of an opaque mastoid did not correlate with residual or recurrent cholesteatoma. The sensitivity of CT in diagnosing residual or recurrent cholesteatoma was 42.9% with a specificity of 48.3% and a predictive value of 28.6%. These results are explained by the fact that it is radiologically impossible to differentiate between recurrence, scar tissue or fluid with a CT scan. Nevertheless it was possible to inspect the cavity with the otoendoscope even in the presence of an opaque mastoid whether due to scar tissue or residual/recurrent cholesteatoma.

Adolescent↗
PubMed1996

Palatal trauma: an unusual cause of a parotid sinus.

A case is described of a 3-year-old boy who presented with a seemingly trivial injury to his soft palate, who went on to develop a parotid sinus as a result of a retained foreign body. This is a rare clinical problem and it highlights the difficulty in the clinical assessment of a palatal injury--especially in children. The child had the foreign body removed successfully 5 months after the initial injury and made an uneventful recovery.

Child, Preschool↗
PubMed1996

Childhood pseudohypacusis.

Pseudohypacusis is a condition in which a hearing loss is exhibited in the absence of any organic disease. The mainstay of diagnosis is a lack of consistency in audiological testing. It is usually easier to diagnose in children than in adults, as children are less able to produce consistently erroneous results on repeated testing. In spite of this, the diagnosis is often missed in children, probably due to a lack of awareness of the condition. We present the findings in ten children seen in the past year. Initially they had average pure tone thresholds of 51.3 db in the right ear and 51.4 db in the left ear. All of the children underwent repeat pure tone audiometry and speech audiometry. In nine cases the speech audiograms confirmed the diagnosis. In one child the speech audiogram was consistent with a mild hearing loss subsequently confirmed as a 30-40 db low frequency sensorineural hearing loss. Following a programme of close follow up and support, the pure tone thresholds returned to within normal limits in nine children and to a level consistent with the clinical impression in the child with a sensorineural loss. None of the children required brain stem evoked response audiograms to confirm the diagnosis.

Age Factors↗
PubMed1996

The role of the Davis graft technique in the treatment of chronic post-mastoidectomy otorrhoea.

The effect of grafting mastoid cavities with small Davis cutaneous pinch grafts was assessed in 15 patients. Following revision of the cavity and Davis pinch grafting the resultant cavity was completely dry in 13 patients (87%) over a period ranging from 1 to 30 months with a mean of 7.3 months, with five becoming dry within 1 month. Patient satisfaction with respect to reduction in discharge and smell was excellent (87%). We believe that the Davis graft technique has a beneficial role in persistent post-mastoidectomy otorrhoea especially when previous standard revision techniques have failed.

Adolescent↗
PubMed1995

Management of retraction pockets of the pars tensa in children by excision and ventilation tube insertion.

Retraction pockets of the pars tensa in children can result in erosion of the ossicles leading to hearing loss and eventually cholesteatoma formation. Several different types of treatment for the more severe grades of retraction pocket have been described. The aim of this pilot study was to assess the outcome following simple excision and ventilation tube insertion of grade II, III and IV retraction pockets of the pars tensa. The eardrums were graded according to Sadé's classification (1979). There were seven grade II and four grade III retractions. Ten eardrums healed completely in a mean time of 3.6 months (mean follow-up 16 months) and there was one residual perforation. Two retractions recurred and both of these were only grade I. Clinically, an improvement in hearing was reported in seven children (eight ears) and the average air conduction threshold gain for these patients was 16 dB. A larger prospective study is currently underway.

Auditory Threshold↗
PubMed1995

Comparison of the otoendoscopic and microscopic anatomy of the middle ear cleft in canal wall-up and canal wall-down temporal bone dissections.

This study was designed to compare the accessibility of particular anatomical sites in the middle ear cleft in five canal wall-up and five canal wall-down temporal bone dissections, using 0 and 70 degree otoendoscopes and the microscope. In all five canal wall-up dissections, otoendoscopy gave good visualization of all sites of the middle ear cleft whereas microscopy failed to give adequate visualization of the sinus tympani and protympanum. In all five canal wall-down dissections otoendoscopy again allowed good visualization of all sites whereas microscopy did not permit visualization of the sinus tympani. It is well known that residual cholesteatoma is most frequently found in the sinus tympani, therefore this makes the otoendoscope an essential adjunct to the microscope in canal wall-up and canal wall-down surgery.

Cholesteatoma, Middle Ear↗
PubMed1995

The use of Davis pinch grafts to promote epithelialization in a post- mastoidectomy cavity.

Otorrhoea following open mastoid cavity surgery is common and is estimated to occur in 10 to 35% of patients. It is usually due to failure of epithelialisation of the mastoid cavity for a variety of reasons. Even in the ideal cavity, which is small with a low facial ridge and large meatus, 10% discharge recurrently. Various techniques designed to promote epithelialisation have been proposed including cavity revision with or without a meatoplasty, cavity obliteration by different methods and partial or total reconstruction of the cavity. No single technique has proved superior. Other approaches that directly address the problem of epithelialisation have been used, including partial thickness skin grafting, autologous and indeed synthetic epidermal cell grafting, with varying degrees of success. We describe the Davis pinch graft technique, as devised by Holsted and popularized by Davis for venous ulcers. Free pinch grafts consisting of epidermis and small amounts of dermis are taken from the anterior abdominal wall and inserted into the revised mastoid cavity. We present a retrospective study of 15 patients who underwent revision mastoidectomy and Davis pinch grafting for persistent ottorrhoea, and discuss the results with respect to patient symptomatology and the surgeons assessment of the cavity. In conclusion, we believe that the Davis pinch graft has a proven beneficial effect in the management of post-mastoidectomy otorrhoea.

Adolescent↗
PubMed1994

Massive epistaxis following sphenoid sinus exploration.

Internal carotid artery trauma is a rare but potentially disastrous complication of surgery to the sphenoid sinus and pituitary gland. Emergency and elective procedures to establish haemostasis are discussed.

Aneurysm, False↗