Neeraj Sethi

Benefits of frenulotomy in infants with ankyloglossia

OBJECTIVESnAnkyloglossia is a common, congenital abnormality often causing feeding difficulties in infants. This study aimed to evaluate indications and outcomes of frenulotomy performed in infants with ankyloglossia for breast-feeding difficulties.nnnMETHODSn85 patients were prospectively identified as they underwent frenulotomy in Pinderfields Hospital ENT outpatient department between February 2008 and February 2011. 52 patients were successfully followed up with a telephone questionnaire about effects on breast-feeding and any complications.nnnRESULTSnAll mothers had experienced problems breast-feeding prior to frenulotomy. Following frenulotomy 40/52 (77%) of mothers reported an improvement in breast-feeding within 2 weeks of the procedure. No complications were reported.nnnCONCLUSIONnThis study supports the view that ankyloglossia is a common cause of breast-feeding difficulties. However the lack of universal improvement in breast-feeding following frenulotomy suggests that it is not the only cause of problems and supports the clinician approaching these situations holistically and exploring other causes.

Endoscopic sinus surgery as day-case procedure

OBJECTIVEnFunctional endoscopic sinus surgery is the mainstay of surgical treatment for chronic sinusitis. Day-case surgery has the advantage over in-patient surgery of being cost-effective and resource sparing. The objectives of this study were to assess our results for day-case functional endoscopic sinus surgery.nnnMETHODSnThis was a retrospective case note review of day-case functional endoscopic sinus surgery procedures performed at Leeds General Infirmary from February 2004 to February 2007. We recorded patients demographic data, operative details, post-operative course and follow-up results.nnnRESULTSnA total of 105 day-case functional endoscopic sinus surgery procedures were included in the study. Patients ages ranged from 16 to 93 years; 44 (41.9 per cent) were female and 61 (58.1 per cent) were male. Of these patients, 39 (37.1 per cent) had chronic sinusitis and the rest (66; 62.8 per cent) had nasal polyposis and sinusitis. Sixty-one patients (58.1 per cent) underwent surgery on the morning operating list, while the rest (44; 41.9 per cent) underwent surgery in the afternoon. Of the 105 patients, 24 (22.8 per cent) had undergone previous nasal surgery. The majority of patients (90/105; 85.7 per cent) were discharged on the same day as surgery. The only complication recorded in this study was bleeding, noted in seven patients (6.7 per cent). At the follow-up appointment, 90/105 (85.7 per cent) patients were satisfied with their post-operative results.nnnCONCLUSIONSnDay-case endoscopic sinus surgery can be performed safely as a day-case procedure. The most important factors for a successful outcome are correct patient selection, in terms of general health and social circumstances, and a dedicated day-case team.

The significance of osteitis in rhinosinusitis

Rhinosinusitis is a disease of multifactorial aetiology. As a profession our insight into this pathological process has progressed enormously over the last few decades. The contribution from environmental, host immunity, microbiology and anatomical factors is well recognised, if not completely understood. The involvement of underlying bone in rhinosinusitis was first recognised experimentally in animals and has subsequently been highlighted as a potentially significant finding in humans with CRS. In this review, the role of bone in chronic rhinosinusitis and the evidence behind that role are discussed. Both histological and radiological findings are presented and the subsequent potential clinical impact and relevance of osteitis in rhinosinusitis patients. Future pathways for research to add to the current knowledge of the impact of bony involvement are also discussed.

Creutzfeldt–Jakob disease and ENT

OBJECTIVEnThis review addresses Creutzfeldt-Jakob disease in the context of ENT, and aims to summarise the relevant history, pathophysiology and implications for contemporary practice.nnnOVERVIEWnCreutzfeldt-Jakob disease is a rare, fatal, neurodegenerative disorder. It is a prion disease with four different subtypes that can only be definitively diagnosed post-mortem. The main implications for the ENT surgeon lie in the risk of iatrogenic transmission. The three facets of assessing individual patient risk are: patient history; tissue infectivity; and procedure infectivity.nnnCONCLUSIONnThis is a controversial area in medicine, and ENT in particular. This review highlights a clinically applicable approach for everyday use.

Short, sharp shock public health campaign had limited impact on raising awareness of laryngeal cancer

Laryngeal cancer has poorer outcomes if diagnosed at a later stage. Improving awareness could encourage earlier presentation and improve outcomes. This study aimed to evaluate a public engagement campaign targeted at raising awareness of laryngeal cancer. An epidemiological study identified high-risk populations in the region. A target population as well as a matched control population was selected. A cancer awareness survey combined with focus groups guided the design of a 3-month multimedia campaign. The survey was repeated post-campaign to evaluate the campaign effectiveness. The study identified populations with the highest rates of laryngeal cancer and late stage disease at presentation. The surveys performed revealed a limited effect of the multimedia campaign in raising awareness of the signs and symptoms of laryngeal cancer. Recall of the campaign also faded rapidly. This is the first public awareness campaign aimed at laryngeal cancer carried out in the UK. The results suggest that short-term campaigns have a limited effect and a more prolonged approach should be considered.

Management of Globus Pharyngeus

Globus pharyngeus is a common ENT condition. This paper reviews the current evidence on globus and gives a rational guide to the management of patients with globus. The aetiology of globus is still unclear though most ENT surgeons believe that reflux whether acidic or not plays a significant role. Though proton pump inhibitors are used extensively in practice, there is little evidence to support their efficacy. Most patients with globus can be discharged after simple office investigations. The role of pepsin-induced laryngeal injury is an exciting concept that needs further study. Given the benign nature of globus pharyngeus, in most cases, reassurance rather than treatment or extensive investigation with rigid oesophagoscopy or contrast swallows is all that is needed. We need more research into the aetiology of globus.

Ethics and the facial plastic surgeon.

The facial plastic surgeon potentially has a conflict of interest when confronted with the patients requesting surgery, due to the personal gain attainable by agreeing to perform surgery. The aim of this review is to discuss the potential harm the surgeon can inflict by carrying out facial plastic surgery, beyond the standard surgical complications of infection or bleeding. It will discuss the desire for self-improvement and perfection and increase in the prevalence facial plastic surgery. We address the principles of informed consent, beneficence and non-maleficence, as well as justice and equality and how the clinician who undertakes facial plastic surgery is at risk of breaching these principles without due care and diligence.

Long-term results with a simple technique of stoma creation after laryngectomy

Stomal stenosis after laryngectomy has a major impact on patient rehabilitation. The major contributory factor is the operative technique. The goal is to achieve a widely patent stoma. The objective of the study was to review the long-term results of the technique of stoma creation used by the senior author (CJW). The simple technique, using skin triangles for tracheostoma creation after laryngectomy, has been used by the senior author for past 6xa0years. Review of 59 cases of total laryngectomy with or without partial pharyngectomies in whom this technique was used for stomaplasty. The technique described for stoma creation after total laryngectomy has been used in 59 patients (48 male, 11 female) over 6xa0years. The follow-up of these patients varies from 6xa0months to 6xa0years. Of these patients 54/59 (91.5%) did not have any problems with the stoma. A total of 5/59 (8.5%) patients, the stoma was narrow. Amongst these patients with narrow stoma, only 1 patient (1.7%) has had dilatation done and the others are managing reasonably with a stoma button. None of the patients in this study has required revision procedures on the stoma. The simple technique of stoma creation described in this study has good long-term results.