Gordon Soo

Excision of the preauricular sinus: A comparison of two surgical techniques

Objectives To compare the long‐term recurrence rate of the standard technique (simple sinectomy) and the supra‐auricular approach (wide local excision) for the surgical management of preauricular sinuses.

The BAHA hearing system for hearing-impaired postirradiated nasopharyngeal cancer patients: a new indication.

Background: Radiation for patients who have nasopharyngeal cancer (NPC) often renders them hearing challenged and facing difficulties from treatment sequelae such as chronic suppurative otitis media and osteoradionecrosis. Conventional hearing aids aggravate otorrhea, and ear moulds traumatize osteoradionecrosis ulcers in the ear canal. The bone-anchored hearing aid (BAHA) hearing system might represent an excellent hearing solution. Objective: To investigate the BAHA benefit and osseointegration results for hearing-impaired postirradiated NPC patients. Study Design: A prospective longitudinal study. Setting: Tertiary university center. Patients: Eleven hearing-impaired postirradiated NPC patients were studied from October 2002 to October 2006. Methods: Two-stage BAHA surgeries were performed. Assessments include pure-tone and speech audiometry, implant integrity, periabutment audit, and patient satisfaction analysis during a 24-month period. Radiation dosimetric analysis and bone sampling at the fixture implant sites were studied. Results: No implant fixtures were lost (follow-up, 13-58 mo). Average patient satisfaction scores were 84.4%, with 80% using their BAHA everyday and 90% using their devices for more than 8 hours. Dosimetric analysis of the implant site revealed that all fixtures were outside the irradiated field. There was a reduction in otorrhea rates after BAHA use over the course of the study. Conclusion: Successful osseointegration was demonstrated in postirradiated NPC patients. Improved subjective hearing clarity, reduced ear discharge rates, and extended BAHA usage times accounted for high patient satisfaction with the BAHA hearing system. This is the first study to demonstrate long-term osseointegration and hearing benefit in postirradiated NPC patients. We recommend the BAHA hearing system for the treatment of chronic suppurative otitis media-related hearing problems in NPC patients.

Spontaneous tonsillar haemorrhage due to von Willebrand's disease

OBJECTIVE We report a case of spontaneous tonsillar haemorrhage due to underlying von Willebrands disease, without symptoms or signs of infection. METHOD Case report and literature review of reported causes of spontaneous tonsillar haemorrhage. CASE REPORT Spontaneous tonsillar haemorrhage is uncommon. Acute bacterial tonsillitis, peri-tonsillar abscess, infectious mononucleosis and idiopathic causes have been reported. Two cases of tonsillitis with underlying bleeding disorders have been reported. We present the first reported case of spontaneous tonsillar haemorrhage secondary to von Willebrands disease, without evidence of tonsillitis. CONCLUSION Spontaneous tonsillar haemorrhage is usually related to infection of the tonsils or peri-tonsillar space. An underlying bleeding disorder should be suspected if no evidence of infection is found.