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Multisystem pathology in refractory otitis media with effusion
Recurrent middle ear effusion is a common problem and so is rhinosinusitis with polyposis. It is not often thought that the problem could be linked to multisystem pathology, such as eosinophilic granulomatous with polyposis. Therefore, repeated grommet insertions and surgical...Timing of surgery in chronic rhinosinusitis: does it matter?
While many patients with chronic rhinosinusitis respond to medical treatment, some do not. The next step for these patients is surgery, but how soon should this be offered? Sooner rather than later seems to be the answer, as Claire Hopkins...Systemic agents in thyroid cancer
For those patients who have disseminated or unresectable thyroid cancer, Dr Arabella Hunt and Dr Kate Newbold review systemic treatments, their differences, toxicities and outcomes. Thyroid cancer is the most common endocrine malignancy. It is subdivided into differentiated (papillary, follicular...
Low risk options following failure of intratympanic gentamicin for Meniere’s
This article is a useful summary of the options available when intratympanic gentamicin (ITG) fails to adequately control vertigo episodes in Meniere’s patients. The authors describe the anatomical reasons that may impede drug delivery to the round window with the...
Management of infantile haemagiomas of the airway
This paper reviews the diagnosis and management of infantile haemagiomas (IH) affecting the airway. Approximately half of infants with this condition would also have cutaneous haemagiomas which are usually in the beard distribution. IH could affect any parts of the...
Quality of life in children following balloon Eustachian tuboplasty
This study aimed to demonstrate the efficacy of balloon Eustachian tuboplasty (BET) in children by assessing their quality of life with the Otitis Media-6 questionnaire (OM-6). The OM-6 questionnaire is the most frequently used instrument to measure health-related quality of...
Preoperative prediction of pain outcomes in patients with trigeminal neuralgia
The authors of this retrospective study have developed a preoperative trigeminal neuralgia (TN) grading system for the preoperative prediction of long-term pain relief after microvascular decompression (MVD). Patients who had become refractory to or developed toxicity to carbamazepine or oxycarbamazepine...
Neuromodulation in drug resistant epilepsy
Treatment of epilepsy can be considered generally as medical or surgical. Anti-epileptic drugs achieve a five-year seizure freedom in 54-70% patients. It is estimated that 50-90% of patients with drug-refractory epilepsy may not be candidates for resective surgery. For example,...
Combination PPI and intralesional steroid treatment for recurrent laryngeal granuloma
The existence of a wide range of treatments for recurrent laryngeal granulomas (repeat surgery, high-dose proton pump inhibitor (PPIs), surgery with botulinum toxin injection, botulinum toxin injection alone, etc) is a testament to the refractory nature of this condition, with...
The use of repositioning chairs in the diagnosis and treatment of BPPV
The authors performed a systematic review assessing the utilisation of multi-axial repositioning chairs, such as the TRV chair and the Epley Omniax Rotator, in the diagnosis and treatment of BPPV. They reviewed nine studies, of which four were prospective studies....
Bones, stones and surgical moans: rethinking PTH dynamics in parathyroid surgery
Intraoperative parathyroid hormone (IOPTH) testing has revolutionised minimally invasive unilateral parathyroidectomy (MIP) as the gold standard treatment for primary hyperparathyroidism, replacing old-timey four-gland exploration. IOPTH testing ensures reliable excision of all hypersecreting glands, including those pesky hard-to-find ones, without relying...
