Pain control for patients with chronic pain following surgery

There is an increasing number of patients with a background of chronic pain presenting to the otolaryngologist. Patients with chronic pain require extra consideration in postoperative pain control due to risk of tolerance and dependence. This article summarises postoperative management...

Complications associated with microlaryngoscopy surgery

Microlaryngoscopy procedures are often considered to be routine procedures at the straightforward end of the ENT operative spectrum. Complications associated with this surgery are thought to be infrequent and primarily related to the possibility of dental trauma and adverse voice...

X-ray vs. intraoperative testing for determining cochlear implant placement

Most cochlear implant centres confirm electrode position after surgery using X-rays to ensure optimal electrode placement. As well as transorbital view X-rays, this team check placement using impedance measures and neural response telemetry (NRT) performed intraoperatively. The former indicates whether...

Tramadol soaked nasal packs for post-septoplasty analgesia

Having had a septoplasty a number of years ago for the potential treatment of snoring, I was intrigued by this paper which compared the analgesic effect of tramadol-soaked and lignocaine-soaked nasal packs following septoplasty. In my practice, I have always...

Predictors of postoperative improvement after endoscopic sinus surgery in patients with chronic rhinosinusitis

Improvement after endoscopic sinus surgery in patients with chronic rhinosinusitis varies considerably. If elaborate preoperative and intraoperative data could be used to predict the postoperative course, management and length of the follow-up could be adjusted to provide optimal care. Two...

Merocel vs Cutanplast Anal packing

This study compared two different nasal dressings after septoplasty. Seventy-six patients acted as their own controls by having one nostril packed with Merocel and one nostril somewhat improbably with Cutanplast Anal (gelatin sponge). It seems that the gelatin sponge was...

Preoperative planning of the surgical patient

This article covers the need to effectively optimise patient status preoperatively to help maximise postoperative outcomes. The article is well written and emphasises close liaison with anaesthetic colleagues particularly regarding airway assessment and nausea and vomiting. As is becoming common...

Power tools dance off

The use of the harmonic scalpel is popular with some head and neck surgeons. This study looked at selective neck dissections for 40 patients with oral cavity carcinoma. They were randomised into harmonic scalpel (HS) use and monopolar electrocautery. The...

Which patients are more likely to have postoperative pulmonary complications after major head and neck?

Postoperative pulmonary complications (PPC) following major head and neck surgery are frequently encountered. Indeed, surgery in the head and neck area itself has been identified as a risk factor for these complications. Microvascular reconstruction is a widely accepted and proven...

IV dexamethasone versus LA infiltration during paediatric tonsillectomy

Postoperative nausea and vomiting following tonsillectomy is important to control for improved oral intake and satisfaction following surgery. Optimal management is still debated. This team from Beirut conducted a randomised double blind clinical trial comparing the effect of intravenous dexamethasone...

Does ‘weekend effect’ alter post tonsillectomy haemorrhage rates?

Staffing levels are generally low over the weekends and senior physicians are less easily available. It is generally believed that this affects patients undergoing high-risk surgery. Whether doing tonsillectomy at weekends adds to the risks of post tonsillectomy haemorrhage is...

Risk factors for post tonsillectomy bleeds

This paper reviews post-tonsillectomy bleeding in 692 patients and attempts to tease out risk factors. The overall bleed rate of 11.6% seems very high. The return to theatre rate was 2.6%. The paper identifies male patients and adult patients as...