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High dose betahistine as effective as, but slower acting compared to intratympanic dexamethasone in intractable Meniere’s disease

The management of intractable Meniere’s disease poses a complex conundrum to otolaryngologists. The focus of treatment is decreasing the severity and frequency of vertigo and tinnitus whilst trying to preserve hearing. Betahistine has been used for many years in the...

Consider PCR testing in culture negative necrotising otitis externa

Necrotising otitis externa (NOE) often does not yield identification of a causative organism to treat although in 90% of cases it is a member of the pseudomonas species. The incidence of fungal NOE is not to be forgotten and this...

Corticosteroid prescribing in ENT - are we at risk of being sued?

Of medications leading to malpractice claims, corticosteroids comprise the third most common. They are used widely and have a significant side-effect profile: hypertension, lipodystrophy, diabetes, avascular necrosis of the femoral head, peptic ulceration and psychiatric reactions to name but a...

Immunosuppresants and ototoxicity

There is a wide range of immunosuppressant drugs ranging from calcineurin inhibitors (e.g. cyclosporine), anti-folic agents (e.g. methotrexate) to anti-TNF and monoclonal antibodies, many of which could be ototoxic. The authors performed a systematic review assessing ototoxicity secondary to immunosuppressant...

Does vocal tremor lead to changes in swallowing function?

Vocal tremor (VT) is a debilitating problem, but remains challenging to treat. Its pathophysiology remains indeterminate and there is a lack of consensus on phenotypes. Clinically, VT is often noted to be present in muscles outside of the larynx, including...

Transoral coblation surgery – a viable option for early laryngeal cancers involving the anterior commissure?

Transoral laser microsurgery is widely considered to represent the ideal treatment modality for early (T1a) laryngeal cancers. With disease involving the anterior commissure however, radiotherapy is often advocated on account of perceived superior voice and airway outcomes, plus potential difficulty...

British Skull Base Society Clinical Consensus Document on Management of Head and Neck Paragangliomas (HNPGLs)

All forms of HNPGLs should be managed by a multidisciplinary team (MDT) of core members from skull base otolaryngology, head and neck surgery, clinical genetics, oncology, endocrinology, vascular surgery, radiology and pathology. Extended members include neurosurgery, endocrine surgery, nuclear medicine,...