Ann F. Dingle

Fistula between the external auditory canal and the temporomandibular joint: a rare complication of otitis externa.

Otitis externa is a relatively common complication of ear syringing. Temporomandibular joint complications of otitis externa are rare. A case of otitis externa with communication between the external auditory canal and the temporomandibular joint is described.

Tympanosclerosis and mini grommets: the relevance of grommet design.

Fifty children with otitis media with effusion undergoing grommet insertion had into one ear a Mini-titanium grommet inserted and into the other ear a Mini-teflon grommet. Post-operative follow-up until after extrusion of the grommets demonstrated only a small difference between the extrusion times of the two grommets (a significant difference of 41 days) and no difference in the degree of tympanosclerosis seen with each grommet. We propose that the mass of a grommet appears to play less of a role than has previously been suggested in the pathogenesis of tympanosclerosis following grommet insertion and that duration of intubation may be the most significant factor.

The mini-grommet and tympanosclerosis: results at two years

One hundred and sixteen children with otitis media with effusion (OME) underwent surgery with grommet insertion. A conventional Shah grommet was used in one ear, and a Mini-Shah grommet in the other. Final review of the subjects two years after surgery revealed a significantly lesser degree of tympanosclerosis in the ear into which the Mini-Shah grommet had been inserted. This benefit might have resulted from the lesser mass of the mini-tube or its shorter duration in situ.

Retropharyngeal haematoma: a diagnosis for concern?

Three cases of retropharyngeal haematoma are described. In one case there was underlying aneurysm of the carotid artery which could have led to significant morbidity if undetected.

Distribution of ear drops in normal ears

Ear drops are prescribed widely with little thought for the distribution inside the ear canal. This study compares the distribution of water and oil based drops. The results indicate that, under the test conditions, the penetration of ear drops is extremely variable. Water provided the greatest overall coverage, while the most viscous drops fared worst. It is suggested that in diseased ears even poorer penetration may result, which may explain the lack of response in some circumstances.

Distribution of ear drops using a non-aerosol spray delivery system

The distribution of ear drops in normal ears is variable. A new product Otomize (Stafford-Miller) containing dexamethasone and neomycin has a non-aerosol spray mist delivery system. This has been applied to normal ears and found to be superior in its distribution to generally available ear drops previously assessed.

The implementation of audit in an ENT unit

ENT Departments in the United Kingdom are faced with increasing pressure from government, management and the Colleges responsible for surgical training to introduce formal medical self audit. The plethora of guidelines and publications on the subject rarely address the differences in clinical practice between general medicine or surgery and that of otolaryngology. Clearly the lead in the introduction of medical audit will come from the appropriate specialist associations; however, this paper aims to share the experience of the implementation of audit in one otolaryngology, head and neck surgery unit and offer suggestions for a programme elsewhere.