Neil Weir

Vocal fold palsy after use of the laryngeal mask airway

We report two cases of left vocal fold palsy following use of the laryngeal mask airway. In both cases anaesthesia was uneventful with a duration of about 60 minutes. It is proposed that high intra-cuff pressures induced during anaesthesia resulted in distension of the hypopharynx and subsequent neuropraxia of the motor branches of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve.

Hearing impairment and ear pathology in Nepal

A stratified random cluster sample of 15,845 subjects was performed in two regions of Nepal to determine the prevalence and main causes of hearing impairment (the most common disability) and the prevalence of ear disease. Subjects reporting current ear pain, or ear discharge, or hearing impairment on direct questioning by a Nepali health worker (primary screening failed), had otoscopy and audiometry (using the Liverpool Field Audiometer) performed, and a questionnaire administered relating to past history. In every fifth house subjects who passed the primary screening (1,716 subjects) were examined to assess the false negative rate of screening. An estimated 16.6 per cent of the study population have hearing impairment (either ear worse than 30 dB hearing threshold level (HTL) 1.0-4.0 kHz, or 50 dB HTL 0.5 kHz), and 7.4 per cent ear drum pathology, equivalent to respectively 2.71 and 1.48 million people extrapolated to the whole of Nepal. Most hearing impairment in the school age group (55.2 per cent) is associated with otitis media or its sequelae. Probably at least 14 per cent of sensorineural deafness is preventable (7 per cent infectious disease, 3.9 per cent trauma, 0.8 per cent noise exposure, 1 per cent cretinism, and 1 per cent abnormal pregnancy or labour). Most individuals reporting current ear pathology (61 per cent) had never attended a health post, and of those receiving ear drop treatment, 84 per cent still had serious pathology. Of subjects who reported ear drop treatment at any time, 31 per cent still had serious pathology. The use of traditional remedies was prevalent.(ABSTRACT TRUNCATED AT 250 WORDS)

History of Otology

From the ‘fire in the heart of the ear’ in the Egyptian papyri to the operating microscope, the history of Otology is traced throughout the major centres of learning in Europe. Ear diseases recognised by the Ancient Greeks and Romans were given a sound anatomical basis by the Renaissance anatomists. By eustachian catheterisation eighteenth century surgeons raised the treatment of deafness from the depths of empiricism, and in the nineteenth century otology became a science. During the first half of the twentieth century mastoiditis was a common disease but with the advent of antibiotics the numbers of acute cases diminished. However, a whole new approach to the surgery of deafness became available with the introduction of the operating microscope and sophisticated electronic audiological equipment.

Sensorineural deafness associated with recessive hypophosphataemic rickets

Two pairs of siblings suffering from recessive hypophosphataemic rickets are presented, three members of which have some degree of sensorineural deafness and all of which have bilateral marked narrowing of the internal auditory canals. The biochemical explanation of the condition is discussed.

European Surgeons Were the First to Perform Neck Dissection

The history of the surgical treatment of cervical lymph node metastases began in the 19th century, and, unfortunately, the initial attempts at surgical treatment of neck metastases were disastrous. Although some European surgeons reported few cases of radical en bloc dissection, the first successful surgical procedure was performed and described in detail by Franciszek Jawdyński, a Polish surgeon, in 1888. George Washington Crile popularized and illustrated radical en bloc neck dissection in the early 20th century.

Community ear care delivery by community ear assistants and volunteers: a pilot programme.

Hearing impairment is a major public health problem in Nepal. The present service delivery, however, is mainly hospital based and is limited to large towns. Those people residing in rural areas lack many basic needs including ear care services. The collaborative community volunteer-based ear care pilot programme implemented in Banke, Nepal aims to reach out to those rural areas by establishing sustainable primary ear care services, empowering and utilizing local resources. The focus of the programme is to promote multi-sector improvement in sanitation, nutrition, immunization, breast-feeding and timely care and support to ear patients to help prevent hearing impairment mainly from the sequelae of otitis media.

History of voice rehabilitation following laryngectomy.

Introduction: The history of voice rehabilitation following laryngectomy is as long as the history of laryngectomy itself. The multitude of methods which have been employed to reduce the disability associated with the loss of the larynx, illustrate the difficulty of finding an optimal method of reestablishing verbal communication while preserving the ability to breathe and swallow.

Recurrent laryngeal nerve palsy and the laryngeal mask airway

[I] WILLIAMS PL, WARWICK R, DYSON M, BANISTER LH, EDS. The Lingual nerve. In: Grays anatorny. London: Churchill Livingstone, 1995. [2] ASAI T, MORRIS . The laryngeal mask airway: its features, effects and role. Canaclim Journal of Anaesthesia 1994; 41: 930-60. [3] JAMES FM. Hypesthesia of the tongue. Anesthesiology 1975; 4 2 359. [4] WINTER R, MUNRO M. Lingual and buccal neuropathy in a patient in the prone position: a case report. Anesthesiology 1989; 71: 4524. [5] LOUGHMAN E. Lingual nerve injury following tracheal intubation. Anaesthesia and Inrensiiw Care 1983; 11: I7 I . [6] TEICHNER L. Lingual nerve injury: a complication of orotracheal intubation. British Journal qfdnaesthesia 197 I ; 4 3 4134. [7] JONES BC. Lingual nerve injury: a complication of intubation. British Journal of Anaesthesia 1971; 4 3 130. (81 SILVA DA, COLINGO KA, MILLER R. Lingual nerve injury following laryngoscopy. Anesthesiology 1992; 7 6 6S(rl. [9] MIRENDA J. Lingual nerve injury. Anesthesiology 1992; 77: 22G1. [lo] HUEHNS TY, YENTIS SM, CUMBERWORTH V. Apparent massive tongue swelling: a complication of orotracheal intubation on the Intensive Care Unit. Anaesthesia 1994; 4 9 414-6.

A historical review of head and neck cancer in celebrities

INTRODUCTION The illnesses of celebrity patients always receive more attention from the general public than those of ordinary patients. With regard to cancer, this fact has helped to spread information about the four major malignancies: breast cancer, prostatic cancer, lung cancer and colorectal cancer. Head and neck cancer, on the other hand, is still not well recognised by the lay public, although the risk factors are similar to those of lung cancer. It was the objective of this analysis to identify cases of celebrity patients, the description of which could help to increase awareness of head and neck cancer, its symptoms and risk factors. METHODS The Internet and medical literature databases were searched for celebrity patients who had suffered from head and neck cancer. RESULTS The search revealed numerous famous head and neck cancer patients. However, only seven cases were documented well in the medical literature. Among the identified persons were one emperor, two United States presidents, a legendary composer, a world-renowned medical doctor, an outstanding athlete and an extraordinary entertainer. In spite of their exclusive position in society, these patients did not have a better prognosis compared with ordinary patients of their time. Only two of the group experienced long term survival and only one was cured. None of these influential figures used their influence to fund research or to promote knowledge about their respective diseases. CONCLUSION The identified cases could help increase public awareness of head and neck cancer. Similar to activities in other oncologic fields, current celebrity head and neck cancer patients should be encouraged to discuss their diseases openly, which could have a positive effect on public health.

Outpatient Fibreoptic Nasolaryngoscopy and Videostroboscopy

A description of the uses and advantages of fibreoptic nasolaryngoscopy is given together with the applications of videostroboscopy.