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L M Flood

Publications and source records attributed to L M Flood.

At least 19 recordsLinked to original sources
PubMed2006

Student-selected components: bringing more ENT into the undergraduate curriculum.

Exposure to otolaryngology is currently minimal in the UK undergraduate medical curriculum. This may lead to difficulties in attracting graduates into higher ENT surgical training and in ensuring a reasonable standard of ENT knowledge amongst primary care practitioners. A recent innovation, of which many ENT units may be unaware, is the introduction to the undergraduate curriculum of 'student-selected components'. Like the traditional elective, this allows students to undertake an attachment to a speciality and department of their choice. Units which do not regularly teach medical students but which have a welcoming and enthusiastic approach to undergraduate training may well be ideal hosts. This paper introduces the concepts underlying student-selected components, outlines the preparation required and offers a template for such an attachment, for which ENT is ideally suited.

Career Choice↗
PubMed2006

Departmental audit of tonsillectomy haemorrhage rates: pitfalls in interpretation.

Concerns that a largely anecdotal increase in post tonsillectomy haemorrhage rates was related to the introduction of disposable instruments have prompted much investigation. The result has been, rather, to highlight other variables influencing this risk, but especially to insist on the following: 1. Training in traditional 'cold' techniques. 2. Regular departmental audit of haemorrhage rates. 3. Presentation of such data to patients to ensure informed consent. This audit demonstrates the pitfalls in interpretation of crude data, unadjusted for case-mix, in predicting individual patient risk and in national ranking of unit performance.

Adolescent↗
PubMed2003

Computed tomography in suppurative ear disease: does it influence management?

The value of high resolution computerized tomography (CT) prior to routine mastoid surgery for cholesteatoma remains controversial. Doubts about sensitivity and specificity, in detecting the extent of underlying pathology and in predicting asymptomatic complications, prevent widespread adoption. This retrospective study looks at the influence of pre-operative scanning on the surgical management of chronic suppurative otitis media over an 18-month period. The radiological findings determined the choice of surgical approach, but contributed less to the decision to operate and the prediction of potential hazards. CT is of most value when the otologist can be flexible in surgical technique, tailoring it to imaging findings.

Cholesteatoma↗
PubMed2002

Audit of stapedectomy results in a district general hospital.

We report a series of 100 stapes operations performed for otosclerosis. The problems in reporting the results of stapedectomies are discussed. The audit showed a difference in the measured results between two consultants. As a result, the consultant with the worse outcome chose to stop operating on patients with otosclerosis. The advantages and disadvantages of a single surgeon performing all the cases are discussed. We advocate a central registry of all surgeons performing stapes surgery to allow periodic national comparative audits.

Bone Conduction↗
PubMed2002

A primary glomus tumour of the facial nerve canal.

Glomus tumours can present in several sites in the head and neck. A red mass in the middle ear, visible on otoscopy generally indicates a glomus tympanicum or glomus jugulare. We present photographic and radiologic evidence of such a lesion arising from the course of the intra-tympanic facial nerve, the Fallopian canal, and review the differential diagnoses.

Aged↗
PubMed2002

CT scanning of middle ear cholesteatoma: what does the surgeon want to know?

The history of surgery for middle ear cholesteatoma is of an evolution of techniques to meet the challenges of inaccessible disease and of post-operative cavity management. The concept has traditionally been of exploration guided by awareness and anticipation of all, possibly asymptomatic, complications. Modern imaging reliably demonstrates surgical anatomy, dictating the ideal approach, forewarns of complications and may reveal the extent of disease. An apparent resistance amongst otologists to universal CT scanning prior to mastoidectomy contrasts with the enthusiasm of skull base surgeons or rhinologists for appropriate imaging.

Cholesteatoma, Middle Ear↗
PubMed2000

A systematic approach to interpretation of computed tomography scans prior to surgery of middle ear cholesteatoma.

The foundation of mastoid surgery for cholesteatoma has traditionally been a thorough knowledge of the anatomy and familiarity with landmarks, constant alertness to detect unsuspected complications and the experience to tailor the surgery to the pathology encountered. Whilst not indispensable, computed tomography (CT) scanning is a useful adjunct whose potential predictive value is only truly appreciated by skilled interpretation. We present a guide to analysis to maximize the value of pre-operative radiology.

Cholesteatoma, Middle Ear↗
PubMed1998

An unusual complication of Cloward's procedure presenting to the otolaryngologist.

We present the case of a 51-year-old lady who developed a CSF leak following a Cloward's procedure (anterior cervical surgery with fusion), which settled with conservative management. Two months following the surgery she was assessed by an otolaryngologist for persistent dysphagia and a swelling in the anterior triangle of her neck. A computed tomography (CT) scan identified a fluid-filled mass displacing the trachea and communicating with the anterior cervical vertebrae, thus confirming the persistence of a CSF leak.

Cerebrospinal Fluid↗
PubMed1998

Early predictors of glucocorticosteroid treatment failure in severe and moderately severe attacks of ulcerative colitis.

OBJECTIVE: To analyse the ability of simple clinical and biochemical parameters to predict glucocorticosteroid (GCS) treatment failure in patients with acute attacks of ulcerative colitis. DESIGN/METHODS: Retrospective analysis of clinical and biochemical data. SETTING: Four Swedish university hospitals. PATIENTS: Ninety seven patients with acute attacks of ulcerative colitis severe enough to warrant treatment with intravenous GCS, hospitalized during the years 1988-93. MAIN OUTCOME MEASURE: Colectomy within the first 30 days after hospitalization, defined as 'clinical steroid resistance'. RESULTS: Thirty days after admission, 39 patients (40%) were in complete clinical and endoscopic remission while 33 (34%) had undergone colectomy. During follow-up for 24 months, four patients among the 39 initially in remission underwent colectomy. Among the 25 patients (26%) not attaining remission after 30 days, an additional nine patients subsequently required colectomy. Steroid resistance was associated with duration of disease (2.7 vs 8.1 years, P=0.0037) and steroid treatment before hospitalization (70 vs 42%, P=0.010). In particular, elevation of body temperature (37.4 vs 36.9 degrees C, P=0.012), persistence of diarrhoea (6.8 vs 3.6 bowel movements/day, P<0.0001) and passage of blood (83 vs 42%, P=0.0003) as well as CRP elevation (36.3 vs 18.0 mg/l, P=0.007) on day 3 after treatment initiation were identified as predictors of a poor response. CRP > or = 25 mg/l and > 4 bowel movements/day on day 3 of hospitalization independently predicted a high risk for colectomy within 30 days. CONCLUSIONS: Sustained elevation of body temperature, persistent bloody diarrhoea and continued CRP elevation on day 3 of intravenous GCS treatment strongly predict clinical steroid resistance in acute attacks of ulcerative colitis. In the group of poor or non-responders, colectomy or more aggressive medical treatment should be considered at an early stage.

Adolescent↗
PubMed1998

Feasibility of otoacoustic emissions as a hearing screen following grommet insertion.

Following grommet insertion, it is important to establish that there is no underlying sensorineural hearing impairment. In this hospital, approximately 1000 grommet insertions are performed each year, thus generating a heavy workload of review appointments for ENT and audiology. The present study investigates the efficacy of performing evoked otoacoustic emissions screening on 108 children when they were ready to leave the hospital following grommet insertion. Bilateral normal otoacoustic emissions were recorded in 32% (35 children), although 99% (105) of the 106 children attending the outpatient review appointment had normal hearing sensitivity. If normal hearing thresholds were established immediately following surgery, it can be argued that this obviates the need for an outpatient review appointment; however, in this study only one-third of children could be discharged after surgery. Otoacoustic emissions therefore does not represent an effective screen at this stage.

Child↗
PubMed1997

Pre- admission clinics in ENT: a national audit of UK practice and opinion.

A one-year prospective audit (1989) of patient non-attendance for elective surgery in our department showed that of those summoned, five per cent defaulted on the day of admission without contacting the hospital (Hampal and Flood, 1992). Contributing factors such as lengthy waiting lists and inefficient communication with the patients were amenable to correction by the hospital. However, the current admission policy made inevitable a significant waste of theatre time. The pre-admission clinic (PAC), an outpatient attendance shortly before surgery, was recommended in ENT practice by Robin (1991) and introduced into our department the year. Failure to attend the PAC allowed adequate time for replacement on the theatre list and was recommended as a solution to the problem of unfilled theatre sessions (Dingle et al., 1993). A subsequent four-year experience of conducting PACs has confirmed several expected advantages. However, some of the hopes for development expressed in our earlier work (Dingle et al., 1993) have failed to materialize. This study aims to review retrospectively our experience and compare it with the admission practice and desires of ENT departments in the United Kingdom as revealed by a postal survey. The findings are of relevance to all surgical specialties and to anaesthetic departments wishing to adopt this system of admission.

Hospital Departments↗
PubMed1997

Cervical osteomyelitis following tonsillectomy.

We present a case of fatal cervical osteomyelitis following an elective tonsillectomy in a previously fit young man. Following induction of general anaesthesia, and prior to surgery, the patient received bilateral glossopharyngeal nerve blocks with 0.5% bupivacaine and adrenaline 1:200,000. The initial recovery was uneventful but persistent throat and neck pain developed at home which was diagnosed as a throat infection and possible hyperextension injury of the neck. It is impossible to say how much the dissection of chronically infected tonsils or the infiltration of local anaesthetic into or near a potentially infected area contributed to the development of cervical osteomyelitis. The absence of any other symptoms and signs, a normal blood count and cervical spine X-ray, and the rarity of cervical osteomyelitis, all contributed to a delay in diagnosis.

Adult↗
PubMed1997

The effect of glossopharyngeal nerve block on pain after elective adult tonsillectomy and uvulopalatoplasty.

This controlled, randomised, double-blind study compared whether glossopharyngeal nerve block and intravenous morphine administered peri-operatively, decreased pain following elective adult tonsillectomy and uvulopalatoplasty more than morphine alone. Sixteen of 30 patients undergoing uvulopalatoplasty and 38 of 78 patients having tonsillectomy received bilateral glossopharyngeal nerve blocks, using bupivacaine 0.5% and adrenaline 1:200,000, or no intervention. There were no differences in postoperative analgesic consumption between the two groups. Visual analogue pain scores measured during swallowing in the recovery room and on the ward postoperatively were significantly less overall in uvulopalatoplasty patients who had received a block (p = 0.004). This difference was not found for tonsillectomy. We found no significant differences between groups, in pain scores recorded during the first 5 days at home. We conclude that glossopharyngeal block does not improve analgesia following tonsillectomy although there is short-lived benefit following uvulopalatoplasty.

Adult↗
PubMed1996

Cochlear implantation in a case of Wegener's granulomatosis.

Cochlear implantation is now a routine clinical procedure for deaf patients in many countries (Gibson, 1987). It replaces the function of damaged cochlear hair cells and therefore, detects sound and by electrical stimulation produces an appropriate signal in the remaining cochlear nerve fibres (House and Berliner, 1991). Wegener's granulomatosis is an uncommon auto-immune disease. It has a peak incidence at the fifth decade with slight male predominance. Nasal problems are the predominant presentation with otological manifestations presenting rarely. We report a case of Wegener's granulomatosis presenting with total hearing loss and after right cochlear implantation a free field threshold of 40 dB and 20 per cent Bamford-Kowal-Bench (BKB) speech test. We conclude that Wegener's granulomatosis is not an absolute contraindication for cochlear implantation.

Aged↗
PubMed1995

An unusual complication following inferior turbinectomy.

Neurological complications following turbinate surgery are relatively rare. We present here an unusual complication of unilateral partial oculomotor and trigeminal nerve palsy after bilateral inferior turbinectomies. The probable aetiological mechanism is discussed.

Aged↗