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ABSTRACT SELECTION
Year : 1998  |  Volume : 1  |  Issue : 1  |  Page : 61-68

Abstracts from proceedings of the irish otolaryngological head & neck scociety


Date of Web Publication16-Jun-2020

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DOI: 10.4103/1319-8491.286860

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How to cite this article:
Gormley PK. Abstracts from proceedings of the irish otolaryngological head & neck scociety. Saudi J Otorhinolaryngol Head Neck Surg 1998;1:61-8

How to cite this URL:
Gormley PK. Abstracts from proceedings of the irish otolaryngological head & neck scociety. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 1998 [cited 2022 Nov 30];1:61-8. Available from: https://www.sjohns.org/text.asp?1998/1/1/61/286860




  Compulsor Audiometry Evaluation Prior to Myringoplasty Top


Mr. Vincent Callanan, FRCS, FRCSI, Mr. Chun Ong, FRCS, Ms. E.B. Chevretton, MS, FRCS.

Guys & St. Thomas’ Hospital Trust, Department of ENT Surgery, 2nd Floor, Lambeth Wing, SL Thomas’ Hospital, Lambeth Palace Road, London, SE1 7EH.

ABSTRACT

Idiopathic sudden severe deafness occurs very occasionally after middle ear surgery, e.g. grommet insertion myringoplasty or modified radical mastoidectomy.

For medicolegal purposes, it is therefore prudent to establish a baseline threshold of hearing levels prior to surgery. This is accomplished by pure tone audiometry, where the thresholds of bone and air conduction are measured.

Part one of this audit (conducted in 1993) found that 62 percent of patients had their hearing tested in the three month period prior to surgery. A new departmental policy was introduced for junior staff. All patients undergoing any ear surgery had to have an audiogram result recorded in their notes prior to surgery. The audiogram had to be performed within the six week period before surgery.

The third part of this audit was completed in February 1996. The aim Was to demonstrate if audit has a lasting impact on clinical practice. The rate of audiogram had remain stable at 95 percent. This confirms that audit has a lasting impact on clinical practice despite changes in a departments junior staff.

This department (Guy’s & Thomas’ NHS Trust/King’s Healthcare) is based on three different hospital sites. The difficulties of audit across this geographically diverse area will also be discussed. Author.


  The Histological Effect of Variable RTP-532 LASER Energy On Tonsil Tissue and It’s Application to LASER Tonsillectomy Technique Top


EJ McNaboe, FRCS, SK Kaluskar, FRCS, S Napier, MRCPath.

ABSTRACT

Laser tonsillectomy is a new alternative to traditional dissection tonsillectomy. ENT surgeons are surprised how difficult the technique is and many discard it without giving it a fair trial. As with all new procedures there is a learning Curve. Once the technique is mastered laser tonsillectomy is a safe quick nontraumatic procedure with minimal morbidity.

In this study, we aimed to demonstrate the histopathological effect of the Potassium Titanyl Phosphate (KPT)-532 laser energy on tonsil tissue. By correlating this to the physics of laser tissue interaction, we propose an evidcnce-bascd technique of laser tonsillectomy which minimizes trauma to the tissues and hence should minimize patient morbidity in the early and late post-operative period.


  Ectomesenchymeal Chondromyxoid Tumour of the Anterior Tongue Top


I Miller*. Geraldine Gallagher+, Joan M Aiderdicc, G. McBride” Dr. Ian Miller, SHO, General Surgery Antrim HospitaH Dr. Geraldine Gallagher, FRCSED, Consultant Otolaryngologist, Antrim Hospital. Dr. Joan M Aiderdicc, FRCPath, Consultant Pathologist, Antrim Hospital.

II. Mr. Greg McBride, FRCSED, Senior Registrar Otolaryngology, Altnagclvin Hospital.

ABSTRACT

ECTOMESENCHYMAL CHONDROMY-XOID TUMOUR of an anterior tongue is a rare, recently described clinical entity. The case reported occurred in a 72 year old woman, who presented with a large swelling on the superior aspect of the anterior two thirds of her tongue. The aetiology, clinical presentation and management of this case is discussed. The treatment of choice is local surgical excision.


  Adenoidal Lymphocytes and the Middle Ear Top


J.P. Pracy, (1) D. Smith, (2) M. E. Periy, (1) A. Whyte. (2)

  1. Division of Anatomy and Cell Biology, United Medical and Dental Schools, Guy’s Hospital, St. Thomas Street, London.
  2. Department of Immunology, Babraham Institute, Babraham, Cambridge.


ABSTRACT

The movement of lymphocytes into the middle ear during the course of an immune response was studied in an animal (Pig, Sus scrofa) model of otitis media. Lymphocytes were obtained from peripheral blood, palatine tonsils and adenoids of BCG-scnsitized MHC homozygous (SLAb/b) inbred Large White pigs. The lymphocytes were radiolabeled with chromium 51 and then injected intravenously into recipient pigs undergoing a middle ear immune response to tuberculin PPD challenge. The middle cars, together with other tissues or the recipient animals, were collected and gamma counted. Lymphocytes from all of the sources entered the inflamed middle car. However, entry was highest when the lymphocytes were of adenoidal origin. This may indicate that, rather than being seeded non-specifically by lymphocytes of mucosal origin or from the peripheral blood, organ specific determinants (addrcssins) are present resulting in the preferential sending of the middle car by adenoidal lymphocytes. These findings may prove to be of importance in the future management of common middle car disease such as otitis media. Authot


  The Development of New Staging System for Recurrent Head & Neck Squamous Cell Carcinoma Top


Peter D Lacy, Jay F Piccirillo

Department of Otolaryngology, Washington University Medical, School, St. Louis, Missouri, U.S.A

ADDRESS FOR CORRESPONDENCE:

Peter D Lacy

Department of Otolaryngology,

Washington University Medical School,

Box 8115, 517 South Euclid Avenue,

St. Louis, MO 63110, U.S.A.

ABSTRACT

The management of recurrent head and neck carcinomas can be frustrating for both physician and patient. This is at least in part due to the lack of an accurate and clinically applicable staging system for these patients. The purposes of this study were: (I) to examine the survival patterns of patients presenting with recurrent tumours of the larynx, oral cavity and oropharynx, and (2) to identify key prognostic factors and combine these factors to create new staging systems, which would be both statistically significant and clinically useful. The methods include a retrospective chart review of 1,049 patients treated at Washington University between 1980 and 1992. Of this group, 373 patients with recurrence were identified. Overall 2-year survival rate was 27% (100/373). Larynx patients had a better 2 year survival rate than those with oral cavity or oropharynx tumours. 50/124 (40%) vs. 52/249 (20%)). Six variables were associated with survival and were entered into a logistic model to determine independent prognostic significance Looking at different tumour sites, three variables remained statistically significant. TNM stage (x2 = 12.9, p = 0.003), extent of recurrence (ͯ2= 18.0, p = 0.0001) and initial treatment (x2 = 11.7, p = 0.0006). The process of conductive consolidation was used to combine these significant variables to create new staging systemsfor larynx and oral cavity/oropharynx. These new staging systems provide accurate estimates or prognosis, involve no new technology to implement, arc statistically | significant and may aid both doctor and patient when planning treatment.


  Management of Small Acoustic Tumours Top


Ms Camilla M A Carroll, MD; Mr Peter E Robin MD. Otolaryngology, City Hospital, Birmingham

Introduction:

The diagnosis of small acoustic tumours in patients with very early symptoms is now possible using gadolinium enhanced magnetic resonance imaging. Controversy exists as to how these patients should be managed. some surgeons recommcnd observation, intervening only When there is evidence of tumour growth on serial imaging studies. Others recommend early sergical removal, as post-operative hearing preservation and facial nerve function is better with small tumours. We present a four year follow-up of these patients with intra canalicular acoustic tumours who were managed conservatively at our department.

Methods:

The case notes of patients with intra-canalicular acoustic tumours managed conservatively in 1993, were reviewed. There were 7 patients, three males and 4 females. The average age at presentation was 53 with a range of 40 to 69 years. The average tumour size was J 57cm with a range of 0.5-0.9cm. All patients had audiograms, brain stem evoked audiometry, caloric testing and ENG studies on presentation. All patients had ycartv audiogram and gadolinium enhanced magnetic resonance imaging.

Results:

Five patients demonstrated no tumour growth or i deterioration in hearing during four years of follow-up. Two patients demonstrated tumour growth with ; deterioration of hearing and no other oto-neurological ! symptoms or signs. Both patients have been offered surgery or stereotactic radiotherapy and both have opted for stereotactic radiotherapy.

Conclusions:

The results of this review demonstrate that small acoustic tumours can be safely followed up by serial imaging.


  Making Aminoglycosides Safe: A Radical Approach Top


Brendan J Conlon,FRSCI; David W Smith ,PhD i Hearing Research Laboratories, Duke University Medical Centre, USA.

There is accumulating evidence to suggest that free radical generation plays an important role in ; aminoglycoside induced ototoxicity. Because transition metals particularly iron, plays an important role in free : radical production, we sought to determine if Gentamicin induced ototoxicity is exacerbated by increases in serum iron levels. To this end, we have assessed the effect of supplemental iron administration (2mg/kg/day and 6mg/kg day)on changes in auditory function induced by co-administration of Gentamicin lOOmg/kg per day for 30 days .experiments were carried out on pigmented guinea pigs initially weighing, 250-300g. Changes in cochealer function were assessed as shifts in compound action potential (CAP) thresholds, estimated, every third day throughout of treatment period, by use of chronic indwellingelectrodes implanted at the round window, vertex and contralateral mastoid. Results show that animals receiving iron in combination with Gentamicine demotstrated a more rapid and profound elevation CAP thresholds compared to animals receiving Gentamicin alone.This effect was seen to occur in a dose depended manner.

In addition We have assessed the ability of the iron chelator Deferoxamine (DFO) to attenuate the hearing loss induced by an ototoxic dose of the aminoglycoside neomycin (lOOmg/kg/ for 14 days). Results show that animals receiving neomycin alone suffered a mean CAP threshold shift exceeding 35dB at all test frequencies (2.0,4.0 and 8.0 kHz) at 30 days post initiation of treatment. In comparison, all animals receiving co-therapy of neomycin and DFO (150mg/kg/BID 14 days) maintained CAP thresholds during the course of the recording period. A statistical comparison of treatment groups showed that, in animals receiving co-therapy with neomycin and DFO, DFOproduced a significant protective effect against neomycin-induced ototoxicity (p<0.001). These results provide further evidence of the intrinsic role of iron in aminoglycoside ototoxicity and suggest that DFO may have a therapeutic role in attenuating the cytotoxic action of aminoglycoside antibiotics.


  Multichannel Auditory Brainstem Implant: Early experience Top


Kinsella, J.B.; Owens,F.D.;Nealon, B.M. Dallas Otology Foundation, Baylor Medical Center, Dallas, USA.

Removal of bilateral acoustic neuromas in neurofibromatosis type 2 usually results in total deafness. Central electrical stimulation of the auditory pathway may restore limited hearing sensation to these patients. To date, we have inserted 6 cochlear corporation multichannel brainstem implants. Two patients were implanted at the time of removal of their first neuroma and the oilier four were implanted at removal of their second tumour. Five patients had satisfactory preoperative electrical auditory brainstem response Successful implantation and rehabilitation has allowed awareness of environmental sounds and improved speech reading. None of our patients has yet developed open speech recognition.


  Neutrophil Fcyrii Receptor polymorphisms in Otitis Media with Effusion Top


S P Shehab AlPahour.D.S.; Kumarartne, R. Jefferies* ; S Abedeh

Department of otolarygology, City Hospital, Brimingham

*Dept of immunology,university of Brimingham Medical School, Birmingham,UK

Encapsulated bacteria arc a major cause of mortality and morbidity in children in the UK and they have been implicated in the aetiology of otitis media with effusion. Protection is provided by macrophage and neutrophil mediated phagocytosis of bactcria opsmised by specific IgG antibody and activated complement component. Neutrophils and macrophages constitutionally express rccptors for the Fc oflgG (FcyR) and are activated when these receptors arc cross-linkcd by multi-valcnt antibody- antigen complexes. There arc three types of Fc rcccplor, FcyRl.FcyRII and FcyRIII. Six isoforms ofthcFcyRH and two allelic forms of the FcyRIIa.FcvRII-R131 and FcyRlI-HBl but not for FcyRU-R131. Since it has also been shown that protective immune responses to encapsulated bactcria arc predominantly antibodies of the IgG2 subclass, directed against carbohydrate antigens, the possibility exists that a contributing factor by individuals presenting with recurrent attacks of otitis media may be homozygosity for the FcyRlI-Rl31 and hence a relative inability to utilise potentially protective antibody.

To investigate the possibility, we have determined the frequency of FcyRIl polymorphism in 250 children with proven otitis media with effusion ( 100 presenting with recurrent attacks of otitis media and 150 presenting with deafness ) and 100 healthy control children. FcyRIIa allotype was detected by southern blotting allele specific oligonucleotide and labelled 32PyATP,a after PCR amplification of the genomic DNA.

Our data suggests that FcyRIIa polymorphisms amy have clinical implications in the presentation of otitis media with effusion and that the FcyRIIa-R131 may be a possible risk factor contributing to susceptibility for infective OME in childhood.


  Nitinol Tracheal Stents- The Material Difference? Top


M. Colreavy, M. Walsh.

Dept. of Otolaryngology.RCSI.

Tracheal strictures arc widely regarded among the most clinically challenging problems facing the otolaryngologist. The advent of Lasers revolutionised their treatment, but their main disadvantage is that they have to be performed frequently and their restenosis is common. We present our experience with the new generation Nitinol stents which have recently been introduced in Ireland. We have found them technically easy to place and by virtue of their self-expanding design diminish the problem of restenosis.

We feel that these stents will add significantly to our treatment options of tracheobronchial strictures in the future.


  Nasopharyngeal Controlled Paediatric Airway Assessment Top


A.Dc Souza: J.Fcnton; N.Mccallion; L.ClaQcy; J.Russeli

Department of Otolarynology, temple Street, Dublin.

The safe and competent management of paediatric latyngotracheobronchoscopy is dependent on close cooperation between the surgeon and anaesthetist. Limitations of traditional modes of endoscopy have included the presence of an endotracheal tube for laryngeal assessment , uniocular bronchoscope vision crude attempts at diameter estimation, inaccurate interpretation of the dynamics of the upper respiratory system awkward methods of vidco-documcntation. Rcccnt improvements in medical technology, anaesthesia and surgical techniques have resulted in the ability to manage paediatric airway lesions in a more effective manner. A technique of nasopharyngeal controlled airway assessment, using rigid endoscopes and telescopes with different angles of vision in conjunction with telemonitoring and video recording has been utilised at .our paediatric department for the past 18 months. The objective of this presentation is to describe the technique and present a review of the patients involved including a video pot-pourri of some unusual cases that have been encountered.Forty eight cliildrcn have been assessed during this period and all the number of procedures per patients ranges from 1-15. This approach provides a safe, controlled exact assessment of the dynamic airway and recording the findings has been invaluable in providing accurate comparisons to the clinical response and progress of the patients population.


  Videofluroscopy and Milk Swallow Endoscopy in the Assessment of Dysphagia Top


Dr Colm Madden, Prof. Conrad Timon Department of Otolaryngology-Head and Neck Surgery, St. James Hospital, Dublin.

Videofluroscopy has long been viewed as the “Gold Standard” of swallowing examination for the comprehensive information it provides. In a pilot study of 12 patients over a six month period, we have compared and contrasted videofluroscopic assessment with that obtaiend by milk swallowing study under fibreoptic endoscopic assessment. The patients had either neurological disease or were post head and neck surgery. The objective was to find if there was correlation between both types of dysphagia assessment and to see whether prognostic factors were identifiable to predict the outcome of such assessments.


  Blood Splash During Tonsillectomy: An Unrecognized Hazard Top


I.J.keogh; M. Colreavy; S.Hone; Prof.M.Walsh

Department of Otorhinolaryngology-Head and Neck surgery, Beaumont Hospital

Transconjctional transmission of blood borne pathogens is a well recognised route of infection.However. few surgeons routinely wear eye protection while operating.We designed a prospective study to investigate the potential for conjunctional contaminatioon during tonsillectomy;iomy: one of the most commonly performed operations.

Sergeons wore a standard pair of eye protection ^tonsillectomy. The number and size of blood splashes found on the eye protection were recorded. Blood splashes were unnoticed by the surgeon. In cases vherc the surgeons were aware of splash events, diathermy was the most common cause.

We conclude that blood splatter may occur during tonsillectomy and recommend routine use of eye protection to avoid this previously unrecognized risk.


  Management of Neck Lumps and Contribution of Age. Site and Duration to Differential Diagnosis. Top


J.P.Huglies; J. Fenton; C. Timon

Department of Otorhinolaryngology,St. James Hospital,Dublin.

The definitive assessment and treatment of patients with cervical masses comprise a significant proportion of cases related to otorhhinlaryngolgoy services. Differential diagnosis and management of these lesions varies with age of the patient as the likelihood of malignancy ingreases significantly in the older patient (greater than 40 years)Our ongoing study of a large group of such patients displays the varied pathology encountered and seeks to assess the role of some factors in raising clinical index of suspicion .Results from the management of over 175 patients are presented, exhibiting a range of Pathology and discouraging premature open biopsy procedures, Additionally, we critically evaluate the contribution to clinical evaluation of patient age, the history and location of neck masses,as indicators of casuative aetiology.


  Acute Infections In Otolaryngology Top


S.W.Yeo; M.J.Donnelly

Department of ENT, St. Michael Ward, University college hospital, Galway.

Infections in ear, nose and throat are still a major cause of morbitity.Major killing diseases, such as diphtheria, have been controlled by immunisation, however,streptococcal sore throats remain common. Although the incidence of rheumatic fever and acute glomerulonephritis has been greadly reduced, middle ear infections associated with a range of bacteria are still an important childhood affliction while the major respiratory virus infections, such as influenza and common cold, remain unconquered.A 6 months prospective study was reviewed on all patients admitted to Royal Victoria Eye &Ear Hospital with infective otolaryngological conditions from 1[st] January 1997 to 30[th] June 1997.The aim of our study is to quantify the types of acute infections that were admitted to RVEEH and to identify the organisms responstble and their sensitivity to antibiotics.A total of 5503 patients were treated in our accident and emeregency department during the 6 months period of which 126 patients were admitted with infective and non-infcctive conditions. Out of these patients who were admitted 64 patients were admitted with acute ENT disease. The mean age of these patients who required hospital stay was 50 years (range 20-90) and the male to female ratio is 31/34. The average duratin of hospitalisation was 5 days. We conclude that antimicrobials may be the sole treatment to infection. The antimicrobial chosen must be active against the infecting organism and in order to be effective must reach the site of infection in a sufficient concentration and for a sufficient length of time.


  The Internet and the Otolaryngologist Top


David Smyth

Department of Otorhinolaryngology - Head & Neck Surgery. Mater Misercordiae Hospital,Eccles Street, Dublin.

Originally conceived by the United States Military as a means of maintaining communications in the event of a nuclear strike, the internet has grown to be a vast worldwide network of computers accessible to anybody with a computer and a modem. Comprising a number of elements including electronic mail (e-mail), die World Wide Web, Newsgroups and information databases amongst others,it is today a massive information repository. This paper dcscribcs the evolution of the internet, what it has to offer the practicing otolaryngologist/ Head and Neck surgeon today, as well as what is likely to be available tomorrow. In addition to the many benefits the interrnal provides, the down side including, security and confidentiality issues,medicolegal issues and peer review issues, will be discussed.


  Quotation and Reference Accuracy in Otolaryngology-Head And Neck Surgery Jouranls Top


J.Fenton;J.Hughes;A .De Souza;D Mcshane Department of Otolaryngology,Adelaid Hospital,.Dublin.

Inaccurate quotations and citations are misleading for the reader and suggest that mendacity may become“accepted fact” The peer review process as applied to quotation and reference accuracy in mcdical journals is variable. It has been established that a high rate or errors of quotation and citation, ranging from 8-56% occur. Currently, There is a dearth of such data on the Otolarviigology/Hcad and Neck Surgery literature. The aim of this study was to determine the incidence of these errors by assessing four selected ENT journals. The Journal of Otology and Laryngology, Clinical Otolaryngology.The Laryngoscope and Annals of Otology. Rhinology and Laryngology comprised (he study group. The first issue of each journal was randomly selected. Errors were categorized as a major or minor. A major error of quotation was assigned if the reference article failed to substantiate , was unrelated or contradiclcd the authors assertions. Major errors of citation were those that prevented immediate identification of the source of reference. A notable number of quotation and citation errors was identified. It is concluded that Ololaryngology/Head and Neck Surgery literature is similar to general mcdical literature in its incidence of errors of quotation and citation and that the onus is on both authors and reviewers to redress the situation.


  Chondrosarcoma of the Nasal Septum Top


Dr Richard Bill

Royal Victoria Hospital, Grosvenor Road, Belfast.

Chondrosarcoma of the nasal septum is a rare tumour with only 36 cases reported previously in the English literature. Two additional cases of this tumour are presented, both young adults who had minimal symptoms at presentation. The aetiology, clinical presentation and management of these cases is discussed. The treatment of choice is wide surgical excision.


  Endoscopic Sinus Surgery (ESS)- A Regional Experience Top


Mr M.Shandilly; Mr A.Martin;Mr K. O’driscoll

Department of Otolaryngology Head and Neck Surgery, Tullamore General Hospital, Co. Offaly.

ESS as an approach to sinus surgery was shown to be increasing in popularity amongst Otolaryngologists in the County. The current study outlinesd the practice of this approach by one surgeon in a regional unit. This retrospective review audits 105 consecutive patients undergoing ESS. The study period was August 1995 to August 1997. Patients had a 6 yvccks period of conservative medical management of oral steroids and antibiotics unless contra-indicated or had anatomic factors necessitating surgery. There were 45 male and 55 female patients with age ranges from 11-80 years of age. Most patients were in the 3[rd] decade. Follow-up ranged from 3 months to 2 years. There was one serious complication of CSF leak and four minor complications, one of periorbital haematoma and three patients with suspected emphysema. Eight patients required revision surgery. The results arc discussed in the light of similar series internationally.


  Nerve Monitoring in Thyroid Surgery- Is it worthwhile? Top


Prof. Conrad Timon

Department of otolaryngology, St. James Hospital Dublin,8.

Introduction:

Although intraoperative nerve monitoring is nowstandard of care in skull base/parotid surgery, this is not the case for thyroidectomy. Monitoring in thryroid surgery is prohibitive bccaucs of ils complexity, invasive nature and reproducibility. The objective of this study was to analyse the use ofNeurosign 100R Nerve Monitor with endotracheal electrode monitor in thyroidectomy.

Materials and Methods:

Consecutive patients undergoing thyroidectomy over a nine month period was monitored. Tire reproducibility, ability to identify and stimulate both recurrent and superior laryngeal nerves were asessed. As a prognostic indicator, the nerve response prior to and after thyroidectomy was compared as was the relative benefits of mono and bipolar electrodes. Three patients undergoing laryngectomy had the recurrent nerve monitored before and after crushing.

Results:

Twenty patients undergoing thyroid surgery over nine months were assessed. Nerve monitoring was successful in all cases. The threshold for stimulation of the recurrent nerve was never more than 0.5mA (range 0.2-0.5mA) for the bipolar and 1.5mA ( range 0.2 to 1.5mA ) for the unipolar electrode. The threshold for the superior nerve was somewhat higher, 1mA and 1.5mA respectively. Although the recurrent nerve was identified clinically in all cases prior to stimulation, in half of the cases the monitor yvas required to find the superior laryngeal nerve. Following resection, stimulation levels of the laryngeal nerves were the same or less than the pre-disscetion threshold. No patient after surgery had evidence of nerve damage. In the laryngectomy petients light crushing of the recurrent nerve markedly increased the stimulation threshold.

Conclusion:

Use of the Neurosign 100 with endotracheal electrode placement is a simple, non-invasive and productive means of nerve monitoring during thyroid surgery. It is helpful in nerve confirmation and particularly useful in localising the superior laryngeal nerve. I recommend using the bipolar electrode set at 30Hz and 0.5m A for the recurrent. and 1.0mA for the superior nerve. Threshold comparison before and after resection would appear to have Prognostic value.


  Orbital complications of Sinusitis. The Royal Victoria Eye & Ear Hospital-A 5 Year Experience Top


M.Donnelly ; M.A.Rafferty;H,Burns.

The orbital complication of sinusitis in the post antibiotic era have become less commonly seen and reported. However, this remains a significant cause of morbitity and mortality. The close proximity of both Opthalmological and ear. nose and throat casualty department in the one institution gave us a unique experience with this condition. We reviewed all such casas over a 5 year period from July 1992 to July 1997. The patients mode of referral and presenting symptoms, diagnostic imaging, microbiology, treatment and follow- up were assessed. Fifty patients in total were studicd,39 men and 11 women. The age range was from3-78 years. Forty two patients (84%) were referrals from the ophtlialmology department with only 8 direct ENT referrals. The primary presenting symptoms were oplitlialinic in 76% and 24% in otolaryngology. Thirty nine patients had no history of sinusitis prior to presentation. Patients were all radiologically assessed with plain x-rays. Additional CT sinuses were performed on 31 patients. Specimens for microbiological culture were obtainable in 31 patients (62%). Of these specimens only 48% yielded a positive culture. Streptococcal and staphylococcal studies were most commonly identified. Forty six per cent of all patients were treated successfully by conservative management only. Of the surgical interventions undertaken acutely, 19 patients had antral lavage, sinus surgery in 9 patients, frontoethmoidectomy mil patients and trephine aspiration of abcess in 4 patients. In a mean follow-up of 1 year, 8 patients (16%) underwent subsequent elective surgery for their sinus disease.


  Belfast Cochlear Implant Centre- The First 5 Years Top


Mr J.E.T.Byrnc; Mr J.Toner

Belfast City Hospital.

Introduction

In the short time allotted for this paper we would like to give a brief outline of the activity and development in our Cochlear Implant Programme during its first 5 years.

We began assessing adult patients in late 1991 and paediatric patients in september 1992. To date, a total of 189 patients have been assessed-109 adults and 80 paediatric

In the 5 years from May 1992 to May 1997 a total of 71 patients have been implanted -37 adults and 34 children, Since then, we have implanted a further 4 Children and 1 adult bringing our current number of patients implanted to 76. we would now like to review some of the developments that have occurred during the past 5 years.Once of the major changes has occurred in the area of selection criteria. Initially cochlear implants were considered only for those who were profoundly deaf- but as the experience has increased and greater confidence in the results achieved has accumulated these criteriahave evolved considerably.

This change is sometimes confusing to those who refer patients. A patient who 2 years ago was considered unsuitable is now suitable. This arises bccausc with the improvement in devices, the range of patients who benefit increases. The current criteria in children arc that they should have no functional progress with hearing-aids and their average aided thresholds should be greater than 60dB for frequencies above 1 KHZ. Often some of these children will have relatively good aided low frequency hearing, but unless their aided tlircsholds for the higher frequencies are better than 60dB, they will usually obtain benefit from an implant.

For adults, our current criteria are; their aided speech discrimination should be less than 25% and average aided pure tone thresholds greater than 60dB for speech frequencies.

The other change which we have adopted is in the surgical approach. We have been using since November 1994, the mini-postauricular incision, popularized by Gibson in Sydney. This is for our last 50 cases.

A slide showed our previous incision which was the standard large extended endaural incision and produced a large flap. Tliis gave a good access, but involved a significant head shave and it did cause some problems both in adults and children.

A slide was shown of a Clarion implant in situ via the large incision approach. This shows what appears to be a standard post auricular approach for mastoid surgery. With retraction,, we can drill the recess for the implant In children, the lateral sinus is often exposed.

A slide was shown of the cochleostomy with the stapedius tendon and long process of incus. A slide was also shown with the implant in place. The package is cemented in place. A good 2 layer closure can be obtained. Then there was a view of the wound 2 weeks postoperatively. It is well healed. With this incsion the morbidity associated with the wound and head shave is considerably reduced.

Another major change in the past 5 years from our point of view, has been the age at which patients have been implanted.

In the slide the yellow bars represent the age distribution for the first 3 years and the red for the past 2 years. In the first 3 years, we implanted a lot of children who were in the 4 year and above range and fewer younger children. This has now reversed and the majority of children arc in the younger age group. This reflects the pattern or reference and realization that early implantation is crucial to maximise benefits.

Another interest that has arisen, from necessity, consists of those patients who were not considered fir for the long hypotensive anaesthesia. We have carricd out 3 implants under local anaesthesia. These have been remarkably straight forward. A video showed two of these patients being switched on during surgery. You could hear their description of what they heard. Quite surprising is that the second patient (the man) appears to be getting some speech discrimination with an extremely rudimentary speech processor map.

The last topic I would like to mention is, the area of changing technology. The early implant devices were quite bulky and heavy mainly due to batteries. However, with technology advance in tliis area, the devices are becoming smaller and more sophisticated - less power hungry.

A slide showed the current Nucleus Splint device. The processor has become smaller and with more advanced controls fro the patient. However, the major breakthrough which is about to occur is the provision of ear level processors. The patient instead of having the cumbersome body worn processor and cable, wears tliis ear level device which looks like a post auricular hearing-aid. New generations of implantees will probably, all, be provided with ear level processors. The benefit for adults lias been well established. This report carried out by the Medical Research Council at the request of the N.H.S. evaluated very thoroughly the use of imlpants in adults.

It is a model of evidence based medical enquiry and has proved the effectiveness of cochlear implantation. One of the most gratifying aspects of tliis work is seeingrapid development of spccch, and language skills, in young children. Another video showed a brother and sister both of whom have been implanted, interacting. They are followed by a small child who is shown both pre-implant and 18 months post implant. The improvement in his speech skills is self-evident.

Finally I would like to leave you with a remark, by one of the scions of otology, William House, which illustrate how rapidly the field of implantation has changed. He says that during die last decade, implantation in children has changcd from being considered unethical to a position now, where it is considered almost unethical not to implant a deaf child.








 

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  In this article
Compulsor Audiom...
The Histological...
Ectomesenchymeal...
Adenoidal Lympho...
The Development ...
Management of Sm...
Making Aminoglyc...
Multichannel Aud...
Neutrophil Fcyri...
Nitinol Tracheal...
Nasopharyngeal C...
Videofluroscopy ...
Blood Splash Dur...
Management of Ne...
Acute Infections...
The Internet and...
Quotation and Re...
Chondrosarcoma o...
Endoscopic Sinus...
Nerve Monitoring...
Orbital complica...
Belfast Cochlear...

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