Abbad Toma

The use of camera mobile phone to assess emergency ENT radiological investigations.

Objectives:  To determine the accuracy of assessment of common ENT emergency radiological investigations using mobile phone digital images.

Silent sinus syndrome

Silent sinus syndrome is defined as a spontaneous and progressive enophthalmos and hypoglobus with hypoplasia of the maxillary sinus and resorption of the orbital floor. It is caused by atelectasis of the maxillary sinus in the presence of ipsilateral chronic hypoventilation of the sinus. The problem may be idiopathic, but the term is now also used to describe cases that follow operation or trauma. We describe three cases, each with a different aetiology, and discuss the clinical and radiographic evaluation of the condition, theories regarding its pathophysiology, and surgical correction.

Oculovagal reflex in paediatric orbital floor fractures mimicking head injury

Background: The oculovagal reflex is well described in ophthalmic surgery, but may be caused by any manner of pressure on the globe. Children with orbital blowout fractures present in a different manner from adults. The classic presentation in children is a white eye injury (ie, no subconjunctival haemorrhage) with upgaze diplopia and general malaise. Methods: A retrospective audit is presented of paediatric and young adult patients referred to the Orbital Service at St George’s Hospital who required surgical intervention. Results: One-third of children with orbital blowout fractures are admitted for head injury observations, while the true cause for the symptoms goes unrecognised and uninvestigated. Conclusions: Orbital blowout fractures in children require more swift intervention than in adults if muscle ischaemia and permanent impairment of the vision is to be avoided. The delay for head injury observation may therefore compromise the surgical outcome.

Nasolacrimal Tuberculosis: Case Report Highlighting the Need for Imaging in Identifying and Managing it Effectively

Purpose: To report a rare case of nasolacrimal tuberculosis, conduct a literature review, and to suggest an optimal management plan. Methods: A 39-year old Zimbabwean female presented with a 3-year history of left epiphora, haemolacria and medial canthal mass. On ophthalmic examination there was no lateral displacement of the left globe. The initial management was external dacryocystorhinostomy. Histology of the biopsy was inconclusive and her symptoms did not improve. This prompted a referral to otolaryngology. Nasal examination revealed a friable mass of the middle turbinate. CT scan showed paranasal sinus and lacrimal sac destruction and lateral displacement of the globe. Endoscopic sinus surgery confirmed the CT findings, allowed a biopsy taken, and the histology showed prominent caseating granulomatous inflammation. Microbiological cultures confirmed nasolacrimal tuberculosis. Conclusion: We report a case of primary tuberculosis affecting the nasolacrimal apparatus presenting with a medial canthal mass. This report highlights the need for high index of suspicion, and initial CT imaging in order to avoid invasive procedures such as external dacryocystorhinostomy, which may cause extra surgical morbidity and delay diagnosis and treatment.

Does Hydrogen Peroxide Mouthwash Improve the Outcome of Secondary Post-Tonsillectomy Bleed? A 10-year Review:

Objective: To determine whether hydrogen peroxide (H2O2) mouthwash influences the outcome of secondary post-tonsillectomy hemorrhage in children. Study Design: Ten-year retrospective study of all children with secondary post-tonsillectomy hemorrhage. Setting: Tertiary otolaryngology center. Results: Of the 156 patients, 59 received H2O2 and 97 did not. All patients received broad-spectrum intravenous antibiotics. The average rehospitalization duration due to hemorrhage was 1.7 days (H2O2 group) and 1.6 days (control group). In the H2O2 group, 8.5% required surgery, compared with 10.3% in the control group. Further hemorrhage episodes requiring readmission occurred in 3.4% of the H2O2 group and 3.1% of controls. There was no difference between the 2 groups in rehospitalization duration (P = 0.49), rate of surgical intervention (P = 0.85), and rate of readmission with further hemorrhage (P = 0.92). Conclusion: Hydrogen peroxide mouthwash does not improve the outcome of secondary post-tonsillectomy hemorrhage in pediatric patients. Significance: This study does not support the common practice of treating post-tonsillectomy hemorrhage with H2O2.

A purely synthetic and biodegradable material for repair of cerebrospinal fluid rhinorrhoea

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Frontal Sinus Mucocele Formation as a Late Complication of External Dacrocystorhinostomy.

Two cases of frontal sinus mucocele post external approach dacrocystorhinostomy (DCR) surgery are reported. The possible anatomical causes of this condition are discussed and in particular, attention is drawn to the consideration of frontal sinus mucocele in patients presenting with frontal sinus symptoms post-DCR surgery.