Peter Prinsley

The burden of revision sinonasal surgery in the UK-data from the Chronic Rhinosinusitis Epidemiology Study (CRES): a cross-sectional study.

Objectives The aim of this study was to investigate the surgical revision rate in patients with chronic rhinosinusitis (CRS) in the UK CRS Epidemiology Study (CRES). Previous evidence from National Sinonasal Audit showed that 1459 patients with CRS demonstrated a surgical revision rate 19.1% at 5 years, with highest rates seen in those with polyps (20.6%). Setting Thirty secondary care centres around the UK. Participants A total of 221 controls and 1249 patients with CRS were recruited to the study including those with polyps (CRSwNPs), without polyps (CRSsNPs) and with allergic fungal rhinosinusitis (AFRS). Interventions Self-administered questionnaire. Primary outcome measure The need for previous sinonasal surgery. Results A total of 651 patients with CRSwNPs, 553 with CRSsNPs and 45 with AFRS were included. A total of 396 (57%) patients with CRSwNPs/AFRS reported having undergone previous endoscopic nasal polypectomy (ENP), of which 182 of the 396 (46%) reported having received more than one operation. The mean number of previous surgeries per patient in the revision group was 3.3 (range 2–30) and a mean duration of time of 10 years since the last procedure. The average length of time since their first operation up to inclusion in the study was 15.5 years (range 0–74). Only 27.9% of all patients reporting a prior ENP had received concurrent endoscopic sinus surgery (ESS; n=102). For comparison, surgical rates in patients with CRSsNPs were significantly lower; 13% of cases specifically reported ESS, and of those only 30% reported multiple procedures (χ2 p<0.001). Conclusions This study demonstrated that there is a high burden of both primary and revision surgery in patients with CRS, worst in those with AFRS and least in those with CRSsNPs. The burden of revision surgery appears unchanged in the decade since the Sinonasal Audit.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) presenting with sudden sensorineural hearing loss

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is an autosomal dominant angiopathy characterized by recurrent cerebrovascular events, migraine and dementia. We describe a case of sensorineural hearing loss as the presenting feature of this condition. We have found no previous reports in the world literature of CADASIL presenting with a sudden sensorineural hearing loss. The significance of questioning a patient with regard to family history is exemplified in this case.

Assessment and management of facial nerve palsy

#### The bottom line #### How patients were involved in the creation of this article We sought feedback on the paper from patient and medical representatives of the charity Facial Palsy UK. We incorporated their comments into the paper and developed a patient consultation guide for management and prognosis of Bell’s palsy (see box below) The facial nerve is important for both communication and expression, and impairment of its function can severely affect quality of life.1 The main concern at first presentation of a facial nerve lesion is to exclude the possibility of a stroke or other serious cause.2 The figure⇓ outlines possible causes. Correct management within the first few days may prevent long term complications. Differential diagnosis of a unilateral facial palsy. Percentages are based on combined epidemiological data from 6024 patients with lower motor neurone facial palsy (rarer conditions including mumps, syphilis, HIV, Guillain-Barre syndrome, otitic barotrauma, myasthenia gravis, systemic lupus erythematosus, sarcoidosis, and multiple sclerosis have been excluded).3 4 *Endemic in forested regions; †misdiagnosed cerebrovascular disease evident in about 1.5% of all patients3 The facial nerve is responsible for motor supply to the muscles of facial expression (frontalis, orbicularis oculi, buccinators, and orbicularis oris) and stapedius, parasympathetic supply to the lacrimal and submandibular glands, …

A unified hypothesis for vestibular dysfunction

It is our hypothesis that three distinct syndromes of vertigo (ie, labyrinthitis, Ménières disease, and BPPV), which arise from a malfunction of the vestibular labyrinth, are in fact a spectrum of disorders all resulting from the presence of free-floating particles within the vestibular fluid chambers.

Is golf bad for your hearing

M A Buchanan and colleagues investigate the possible hazards of modern drivers

Spitting in the ear: a falsified disease using video evidence

We present the case of Munchausens syndrome by proxy (MSBP) in which the mother spat and placed blood in her childs ear, and videoed the result, in order to gain the attentions of the medical profession. This is the first case report of this kind and may represent a disturbing trend in the use of digital photography and video to support factitious illnesses.

Ballooned trachea as a consequence of intubation

A case of iatrogenic tracheal dilatation is presented. This potentially fatal complication of endotracheal intubation may escape early detection. It is well demonstrated by CT scanning.

Frontal mucocele caused by an ectopic maxillary tooth

OBJECTIVE To present a previously unreported cause of frontal mucocele. CASE REPORT A patient presented with a frontal mucocele and maxillary sinusitis. Computed tomography revealed an ectopic maxillary tooth as the cause of her signs and symptoms. Removal of the tooth by a Caldwell-Luc procedure facilitated resolution of the mucocele. Conventional treatment of mucoceles by endoscopic sinus surgery, and other rhinological sequelae of ectopic teeth, are considered. CONCLUSION This is the first documented case of an ectopic tooth causing a frontal mucocele, and demonstrates how effectively the patients symptoms resolved on removal of the tooth.

Sudden unilateral deafness after bilateral knee replacement

This case report presents profound unremitting hearing loss in a 76-year-old man after having a bilateral knee replacement. There have been no other cases of permanent post-operative deafness after joint replacement in the world literature. Sudden post-operative deafness is rare. We conclude that this mans deafness is due to a fat embolism in his auditory circulation.

Prevalence of asthma, aspirin sensitivity and allergy in chronic rhinosinusitis: data from the UK National Chronic Rhinosinusitis Epidemiology Study

BackgroundChronic rhinosinusitis (CRS) is a common disorder associated with other respiratory tract diseases such as asthma and inhalant allergy. However, the prevalence of these co-morbidities varies considerably in the existing medical literature and by phenotype of CRS studied. The study objective was to identify the prevalence of asthma, inhalant allergy and aspirin sensitivity in CRS patients referred to secondary care and establish any differences between CRS phenotypes.MethodsAll participants were diagnosed in secondary care according to international guidelines and invited to complete a questionnaire including details of co-morbidities and allergies. Data were analysed for differences between controls and CRS participants and between phenotypes using chi-squared tests.ResultsThe final analysis included 1470 study participants: 221 controls, 553 CRS without nasal polyps (CRSsNPs), 651 CRS with nasal polyps (CRSwNPs) and 45 allergic fungal rhinosinusitis (AFRS). The prevalence of asthma was 9.95, 21.16, 46.9 and 73.3% respectively. The prevalence of self-reported confirmed inhalant allergy was 13.1, 20.3, 31.0 and 33.3% respectively; house dust mite allergy was significantly higher in CRSwNPs (16%) compared to CRSsNPs (9%, p < 0.001). The prevalence of self- reported aspirin sensitivity was 2.26, 3.25, 9.61 and 40% respectively. The odds ratio for aspirin sensitivity amongst those with AFRS was 28.8 (CIs 9.9, 83.8) p < 0.001.ConclusionsThe prevalence of asthma and allergy in CRS varies by phenoytype, with CRSwNPs and AFRS having a stronger association with both. Aspirin sensitivity has a highly significant association with AFRS. All of these comorbidities are significantly more prevalent than in non-CRS controls and strengthen the need for a more individualised approach to the combined airway.