Kim Wong Ah-See

Sinusitis and its management

Sinusitis is one of the most common diagnoses in primary care. It causes substantial morbidity, often resulting in time off work, and is one of the commonest reasons why a general practitioner will prescribe antibiotics.1 #### Summary points We searched Medline for recent papers (1996-2006) using “sinusitis”, “rhinosinusitis”, “acute”, “chronic”, “diagnosis”, and “management” as keywords. We also searched the Cochrane Database of systematic reviews using the keywords “sinusitis” and “rhinosinusitis”. In addition, we used a personal archive of references relating to our clinical experience and updates written for Clinical Evidence . Sinusitis is generally triggered by a viral upper respiratory tract infection, with only 2% of cases being complicated by bacterial sinusitis.2 About 90% of patients in the United States are estimated to receive an antibiotic from their general practitioner, yet in most cases the condition resolves without antibiotics, even if it is bacterial in origin.3 Most general practitioners rely on clinical findings to make the diagnosis. Signs and symptoms of acute bacterial sinusitis and those of a prolonged viral upper respiratory tract infection are closely similar, resulting in frequent misclassification of viral cases as bacterial sinusitis. Boxes 1 and 2 list common and rarer causes of rhinosinusitis. #### Box 1: Common causes of rhinosinusitis

Is secondary haemorrhage after tonsillectomy in adults an infective condition? Objective measures of infection in a prospective cohort.

Objectives:  Traditionally secondary post‐tonsillectomy haemorrhage has been thought to be due to post‐operative infection and as such is treated with broad‐spectrum antibiotics. The aim of this study was to identify clinical evidence of infection in patients with secondary post‐tonsillectomy haemorrhage that might justify the use of antibiotics in these patients.

Head and neck cancer assessment by flexible endoscopy and telemedicine

We have conducted a feasibility study to establish whether ENT tele-endoscopy would be a suitable method of service delivery for patients who live in the Shetland Islands. Ten clinics were conducted over a period of 17 months using ISDN-based videoconferencing at a bandwidth of 384 kbit/s. A total of 42 patients were seen in Aberdeen via videoconferencing for a head and neck cancer assessment. Feasibility was confirmed after the first 20 patients, following positive feedback from all concerned and the absence of any significant clinical or technical problems. A total of 42 journeys was avoided, each journey saving 123 kg CO2 per person. A preliminary cost analysis showed that the threshold at which tele-ENT became cheaper than travel was a workload of 35 patients/year. The actual workload during the pilot study was 29 patients/year. A national telemedicine service for the initial assessment of potential malignancy has the potential to reduce unnecessary transfers to specialist centres, with accompanying reductions in carbon emissions.

Unilateral Opacification of Paranasal Sinus CT Scans

Objectives The aim of study was to describe the histopathology in patients with unilateral sinus opacification and to identify variables that may predict neoplastic pathology. Study Design A retrospective review of paranasal sinus CT scans performed between 2000 and 2003 was conducted to identify patients with unilateral sinus opacification. Results Twenty-eight of 1118 CT scans showed unilateral sinus opacification. Twelve patients had neoplastic disease, 13 had inflammatory disease. Nasal discharge was more common in inflammatory than neoplastic disease (P = 0.009). A polyp or mass lesion was more common on nasendoscopy in neoplastic than inflammatory disease (P = 0.01). Bony erosion was only identified in malignant disease. Conclusion A wide variety of pathologies present with unilateral sinus opacification on CT scanning. In our series, neoplastic disease was more associated with a visible polyp or mass lesion and less with nasal discharge. Bony erosion on CT scan was only seen in malignant disease. Histologic confirmation remains obligatory for diagnosis.

Use of complementary and alternative medicine by patients attending a head and neck oncology clinic

INTRODUCTION Within the United Kingdom, there are 50,000 practitioners of complementary and alternative medicine, with five million people consulting these practitioners yearly. The aim of this study was to explore the use of such therapies by patients attending a head and neck oncology clinic in Aberdeen. METHOD Questionnaires were distributed to 200 patients over an eight-week period. The questionnaire consisted of questions regarding: demographic factors; 48 listed herbal preparations and alternative therapies; reasons for their use; and opinions on their efficacy. RESULTS One hundred and thirty-eight patients completed the questionnaires. Fifty per cent (69/138) of respondents had used complementary and alternative medicine previously, with 26 per cent having used it in the preceding year. Fifty-five per cent of respondents learned about complementary and alternative medicine use from friends, and the majority obtained such medicines by purchasing from a shop. Fifty per cent (34/69) of respondents stated that their family physician was unaware of their use of complementary and alternative medicine. CONCLUSION All medical practitioners should be aware of increasing complementary and alternative medicine usage by the United Kingdom population, and should be able to counsel patients appropriately.

Interdigitating dendritic cell sarcoma of the parotid gland

Interdigitating dendritic cell sarcomas (IDCSs) are extremely uncommon tumours that arise predominantly in lymphoid tissue. We report a case of an IDCS arising in the parotid gland of a 73-year-old man. Clinically, a primary salivary gland tumour was suspected but fine needle aspiration cytology suggested a soft tissue tumour. A diagnosis of IDCS was made on histopathological examination of the resection specimen, with subsequent confirmation by electron microscopy. Given the extreme rarity of this tumour at this site, it is unlikely to be a common diagnostic problem, but the importance of multiple diagnostic modalities is emphasized. The findings of cytology, histology, immunohistochemistry and electron microscopy have not previously been described together in a single case report of this tumour.

The use of complementary and alternative medicine by patients attending a general otolaryngology clinic: can we afford to ignore it?

BACKGROUND There is growing interest in use of complementary and alternative medicine (CAM) among the general population. Little information is available, however, on CAM use in adults attending an otolaryngology outpatient clinic in the UK. OBJECTIVE The purpose of this article is to study the prevalence and pattern of CAM use among adult patients attending the ear, nose, and throat (ENT) clinic in a UK teaching hospital. STUDY DESIGN A cross-sectional study was used. SUBJECTS AND METHODS All patients on their primary visit to an ENT clinic were asked to complete an anonymous questionnaire for a 14-week period from October 2005 to January 2006. RESULTS Based on 1366 completed questionnaires, 53% (728/1366) were female and 47% (638/1366) were male. Twenty-nine percent (395/1366) were older than 60 years, and 56% (763/1366) were married. Twenty percent (275/1366) had a university education. Sixty-one percent (833/1366) had used CAM, almost 36% in the preceding 12 months. The popular remedies were cod liver oil (368/833), garlic (197/833), cranberry (181/833), aloe vera (176/833), primrose oil (174/833), and Echinacea (163/833). Nonherbal therapies included massage (230/833), acupuncture (186/833), aromatherapy (135/833), chiropractic (121/833), reflexology (119/833), and homeopathy (110/833). Seventeen percent (143/833) used CAM for their current illness. Only 8% (64/833) found CAM ineffective; yet, 57% (473/833) would recommend CAM to others. Fifty-one percent (421/833) failed to inform their primary physician of their CAM use. CONCLUSION Despite concerns over CAM efficacy, safety, and cost effectiveness, use of CAM is popular among patients attending an ENT clinic. Their use is not generally related to their presenting illness. Otolaryngologists should be aware of current trends in CAM use when managing patients, including possible interactions with other medication.

Head and neck cancer pain: systematic review of prevalence and associated factors.

ABSTRACT Objectives Pain is a major symptom in patients with cancer; however information on head and neck cancer related pain is limited. The aim of this review was to investigate the prevalence of pain and associated factors among patients with HNC. Material and Methods The systematic review used search of MEDLINE, EMBASE and CINAHL databases to December 2011. Cancers of the oral mucosa, oropharynx, hypopharynx and larynx were included in this review with pain as main outcome. The review was restricted to full research reports of observational studies published in English. A checklist was used to assess the quality of selected studies. Results There were 82 studies included in the review and most of them (84%) were conducted in the past ten years. Studies were relatively small, with a median of 80 patients (IQR 44, 154). The quality of reporting was variable. Most studies (77%) used self-administered quality of life questionnaires, where pain was a component of the overall scale. Only 33 studies reported pain prevalence in HNC patients (combined estimate from meta-analysis before (57%, 95% CI 43% - 70%) and after (42%, 95% CI 33% - 50%) treatment. Only 49 studies (60%) considered associated factors, mostly tumour- or treatment-related. Conclusions The study has shown high levels of pain prevalence and some factors associated with higher levels of pain. There is a need for higher quality studies in a priority area for the care of patients with head and neck cancer.

Infrasellar craniopharyngioma presenting as epistaxis, excised via Denker's medial maxillectomy approach.

Infrasellar craniopharyngioma is an uncommon neoplasm. Rarely, it presents with epistaxis. To date, 39 cases of infrasellar craniopharyngioma have been reported in the world literature. Involvement of the maxillary sinus has only been reported once. We report a second case exclusively involving the nasal cavity, ethmoid sinus and maxillary sinus. Excision was performed using a Denkers medial maxillectomy approach.

Management of chronic rhinosinusitis

#### Summary points Chronic rhinosinusitis (CRS) is a common medical condition presenting to the primary care physician. The 2012 update of the European Position Paper on Rhinosinusitis and Nasal Polyps (EP3OS) reported that it may affect between 5% and 15% of the population in Europe and the United States, although high quality epidemiological data is scarce.1A multicentre questionnaire survey of adults in Europe estimated that one in ten participants had CRS but with notable geographic variation.2 Prevalence estimates for nasal polyps are difficult to achieve given the need for nasal endoscopy for a reliable diagnosis—questionnaire data may overestimate the prevalence of nasal polyps.3 One American study analysing a multiemployer database from 1991 ranked sinusitis as the ninth most costly health condition.4 #### Sources and selection criteria We searched Medline, the Cochrane Library, and PubMed using the search terms “chronic rhinosinusitis”, “rhinosinusitis”, “rhinitis”, “sinusitis”, “chronic disease”, and “nasal polyps”. We also referenced expert position papers such as the European Position Paper on Rhinosinusitis and Nasal Polyps.1 When possible, we used level I evidence from systematic reviews or randomised controlled trials. Rhinosinusitis is the appropriate term used to describe the common concurrence of inflammation and infection within the nasal passages and paranasal sinuses.5 The EP3OS taskforce (a group of international experts who appraise and report on the available literature) developed a clinical definition of rhinosinusitis that is based on the Allergic Rhinitis and its Impact on Asthma (ARIA) group guidelines (box 1).1 …