Biomedical subjects
Publications and source records attributed to M J Brockbank.
Tracheoesophageal puncture is an established procedure for voice restoration following laryngectomy. A method using a flexible gastroscope and a percutaneous endoscopic gastrostomy (PEG) set is described. This overcomes a number of problems and complications which may be encountered when using a rigid endoscope.
Prior to flexible transnasal endoscopy (FTE) topical intranasal agents such as cocaine or combinations of a local anaesthetic and vasoconstrictor agent are generally recommended for local anaesthesia, easier access, and better examination of the interior of the nose, especially the middle meatus. This double-blind study involved 60 patients. Each had five per cent cocaine sprayed in one nostril and normal saline in the other. The pain/discomfort and gag scores showed no statistical difference. Forty-two (70 per cent) patients had a moderate/marked deviation of the nasal septum. A significant pain score (3-5) was obtained in 33.3 per cent of cases with the deviation towards the cocaine side and in 37 per cent of cases with the deviation towards the saline side. Ease of procedure scores for both sides were also comparable, when deviation of the nasal septum was taken into account.
Hereditary haemorrhagic telangiectasia (Osler-Weber-Rendu syndrome, Osler's disease) is an inherited abnormality of the vasculature characterized by abnormal subepithelial vessels. Treatment has included repeated intranasal cautery, intra-arterial embolization and arterial ligation. Historically, the operation of septodermoplasty and the use of systemic/topical oestrogens have been the most effective and lasting treatments, but over time the telangiectasias recur. There is increasing interest in the use of a variety of lasers for intranasal photocoagulation. A report of nine patients suffering from hereditary haemorrhagic telangiectasia who have undergone laser treatment with the Chromos pulsed dye laser is presented. This laser produces light energy at a wavelength of 585 nm and causes localized thermal damage to the blood vessel wall. Initially, no patient saw an improvement in their symptoms, but following an average of approximately three courses of treatment, all have reported a measurable reduction in the number of epistaxes suffered. Although no treatment completely resolves the epistaxis associated with this condition, we have found the pulsed dye laser to be effective at treating telangiectasias within the anterior nasal cavity.
A report of the first 100 patients treated in the multidisciplinary Dysphagia Clinic in Salisbury District Hospital is presented. It was established in January 1992 and involves the Departments of ENT Surgery, Clinical Radiology and Speech and Language Therapy. In the first 18 months, 100 patients have been assessed and treated. These included 46 males and 54 females, between the ages of four and 93 years. Neurological problems accounted for 39 cases. The management comprised the assessment clinic, videofluoroscopy in 83 patients, and finally the appropriate treatment. Forty-four patients were treated primarily by swallowing therapy. Seventy-three patients showed complete recovery, resolution of their symptoms or did not require treatment. Two patients were still under treatment at the time of writing this paper.
A total of 163 children were entered into a case-control study to determine whether any causal relationship exists between otitis media with effusion (OME) requiring grommet insertion and parental smoking. One hundred children with persistent OME formed the case group and 63 children with normal ears formed the control group. The prevalence of parental smoking in each group was then compared. Information was collected by questionnaire and further details about the subjects with regard to surgery of the upper respiratory tract were also gathered. Analysis of findings in this study and previous reports has failed to demonstrate a significantly increased prevalence of smoking in at least one parent, amongst children with persistent otitis media with effusion requiring surgical intervention.
This retrospective, comparative study involves 13 patients with sphenoiditis from 2 specialist centres: the Royal National Throat, Nose and Ear Hospital, Gray's Inn Road (7 patients) and the National Hospital for Nervous Diseases, Queen's Square (6 patients). It was found that the ENT patients had a very much longer history, had more nasal symptoms, and suffered none of the neurological complications attributable to the disease. All the neurological patients presented with a complication after a comparatively short history and had few nasal symptoms. One ENT patient was found to have a mucopyocoele, whereas 5 were found in the neurological patients, all of whom had bony deficiencies demonstrated by radiology and at surgery. Once diagnosed and treated the ENT patients all made full recoveries while 3 of the neurological patients remain with sequelae of the disease. Our study suggests that dehiscences of the surrounding bone increase the risk of potentially serious intracranial problems from sphenoiditis, whereas the chronicity of symptoms is of secondary importance.
Sleep screening was used to discover the incidence of sleep apnoea in 50 children undergoing routine adenotonsillectomy for recurrent upper respiratory tract infections, randomly selected from the waiting list. Preoperative assessment included a detailed parental history, physical examination, and lateral cephalometry, in order to identify factors that might alert the clinician to a diagnosis of obstructive sleep apnoea. There were 2 equal groups of snorers and non-snorers (grade 0); 1 patient was found to have the sleep apnoea syndrome (IV), 9 patients had obstructive snoring with apnoeic episodes (III), 3 patients had snoring with a disrupted sleep pattern (II), and 12 patients snored with no disruption of sleep (I). In identifying patients with apnoea, a history of snoring was unhelpful, whereas one of breathing irregularities was found to be highly specific. Nasal obstruction correlated poorly; however, there was a significant relationship between tonsillar position and size and sleep grade (Chi-squared P less than 0.01). Stepwise regression analysis showed a large contribution to the grading was made by the size of the oropharyngeal airway measured by lateral cephalometry. The children in grade II-IV were re-studied 3 months post-operatively and all reverted to grades 0 or I.
Snorers represent a heterogenous group that require adequate assessment before recommending surgical treatment. There are unfortunately no specific features either in the history or physical examination that might predict those chronic snorers with obstructive sleep apnoea. We have used trained observation together with pulse oximetry ('sleep screening') and fibreoptic nasendoscopy with Muller manoeuvre in our unit to assess snorers. This combination is a reliable means of distinguishing apnoeic patients from simple snorers and determining the level of the obstructing segment. We report our experience in using these methods in the management of 71 chronic snorers. We stress the value of conservative management, and emphasize that obesity, habitual alcohol ingestion and nasal obstruction should be corrected before embarking on pharyngeal surgery.
The Rhinitis Clinic at the Royal National Throat Nose and Ear Hospital is a direct referral clinic dealing with approximately 300 new cases a year. Last year three cases of spontaneous CSF rhinorrhoea were diagnosed. In each case long term topical steroid sprays had been prescribed and the patients had been referred for further management of their 'rhinitis'. Spontaneous CSF rhinorrhoea is potentially life threatening as failure to recognize the problem may lead to the development of meningitis and possibly death. The diagnosis is simple and is based on a good clinical history which may be confirmed by chemical pathology. Radiology is often non-contributory, the site of the leak may have to be identified at surgery. Morbidity and mortality are reduced if an extracranial, trans-nasal/external ethmoid route for repair of the fistula is employed. Three case reports are presented and the diagnosis and management of CSF rhinorrhoea is reviewed.
Non-Hodgkin's lymphoma of the larynx is uncommon and when it occurs usually presents as a non-ulcerating supraglottic mass with a predilection for the ventricle. No case of the lymphoplasmacytic variety occurring in the larynx has been reported in the literature to date. We present such a case with distant lesions in the soft palate and nasal cavity, mimicking nasal polyps.
In this retrospective study of 130 ears over a 5-year period, the effect of intubation with the Goode T-tube was evaluated. The tubes improved the hearing in 86% of ears with a conductive loss secondary to a middle ear effusion to an average 5 dB airbone gap. They improved the early stage retracted tympanic membrane but had no effect on the established postero-superior retraction pocket. They were successful in treating barotrauma. The main complication with their use was otorrhoea which occurred in 28% of ears, and persistent perforation occurring in 6% of the ears. Seventy-seven per cent of tubes were in place after 36 months. Extrusion was significantly related to infection in the ear, and also to the presence of glue on insertion but there was no correlation between the number of previous grommets or the age of the patient. The Goode T-tube is advocated for use in middle ear effusion refractory to conventional grommet insertion or that due to cleft palate.