Laryngeal sensory testing in the assessment of patients with laryngopharyngeal reflux

The Journal of Laryngology & Otology Cambridge University Press

Copyright © JLO (1984) Limited 2009

doi:10.1017/S0022215109991587

Short Communication

O T Dale^{a1 c1}, O Alhamarneh^a1, K Young^a1 and S Mohan^a1

^a1 Derby Voice Clinic, Department of ENT Surgery, Derbyshire Royal Infirmary, Derby, UK

Abstract

Laryngopharyngeal reflux is commonly encountered in the ENT out-patient setting. It leads to impaired sensory capacity of the laryngeal mucosa. The sensory integrity of the laryngopharynx can be evaluated through endoscopic administration of pulsed air, which stimulates the laryngeal adductor reflex. The pressure of air needed to elicit this reflex indicates the degree of sensory impairment. Such laryngeal sensory testing gives a quantifiable means of assessment in patients with laryngopharyngeal reflux, and can be used to measure the response to treatment. Laryngeal sensory testing is safe and well tolerated by patients.

(Accepted June 29 2009)

Correspondence:

^c1 Address for correspondence: Mr Oliver T Dale, Department of ENT Surgery, Musgrove Park Hospital, Taunton TA1 5DA, UK. Fax: 01332347141 E-mail:otdale@doctors.net.uk

‘Honeycomb’ tegmen: multiple tegmen defects associated with superior semicircular canal dehiscence

The Journal of Laryngology & Otology Cambridge University Press

Copyright © JLO (1984) Limited 2009

doi:10.1017/S0022215109991411

R Suryanarayanan^{a1 c1} and T H Lesser^a1

^a1 Department of Otolaryngology, Aintree University Hospitals National Health Service Foundation Trust, Liverpool, UK

Clinical Record

Abstract

Objective: To report the coexistence of multiple tegmen defects, forming a ‘honeycomb’ pattern, together with dehiscence of the superior semicircular canal.

Case reports: We describe three cases in which the above findings were noted, and we review the relevant literature.

Conclusion: Superior semicircular canal dehiscence is defined as the absence of portions of bone over the canal along the floor of the middle fossa. Most published articles describe the defect as an isolated finding which is either unilateral or bilateral. Studies on temporal bones show either a defect over the superior semicircular canal or isolated defects over the tegmen. We describe three cases in which we found multiple tegmen defects, giving a characteristic honeycomb appearance, coexisting with dehiscence over the superior semicircular canal. This finding, which supports the theory of a developmental defect as the origin of the condition, has not previously been reported. A literature review is presented, with discussion of the aetiology and management of superior semicircular canal dehiscence.

(Accepted June 15 2009)

Geriatric otolaryngology toolbox: What you and your nurse can do to improve outcomes for older adults

ENT Journal Oct 2009


by P.A.C. van Vuuren, MD, Sarah H. Kagan, PhD, RN, and Ara A. Chalian, MD, FACS
Abstract

Interest in addressing the health needs of older adults and improving their outcomes is burgeoning in otolaryngology, but the availability of practical strategies to achieve these aims is limited. In this article, we describe how otolaryngologists can capitalize on collaboration with nurses to create a toolbox of quick and effective strategies that can be incorporated into outpatient otolaryngology practice. The toolbox was compiled by a collaborative team of three: an otolaryngologist-head and neck surgeon who specializes in microvascular reconstruction, a geriatrician completing a second residency in otolaryngology, and a gerontologic clinical nurse. We selected and developed these strategies to fit within the framework of standard otolaryngology practice based on evidence we gathered from the geriatric literature and our own collective academic and clinical experience. We review our criteria for selecting each of the 10 items in our toolbox, and we discuss the potential benefits of each.

The evidence for reducing inferior turbinates

Rhinology 47 (3), 227-36 (Sep 2009)
Willatt D
Nasal obstruction is commonly due to enlargement of the inferior turbinate. This review discusses the pathophysiology of turbinate enlargement, the indications for, and methods and outcome of turbinate reduction. All techniques are successful but vary in their long-term efficacy, their propensity for complications and the degree to which they may adversely affect nasal function. Newer techniques under local anaesthetic and often endoscopic control offer outpatient treatment with satisfactory outcomes. However selecting a particular technique should take account of the individual patient's features, the surgeon's experience and judgement and informed patient choice.

Adenoidectomy for otitis media with effusion in 2-3-year-old children

Int J Pediatr Otorhinolaryngol
Casselbrant ML, Mandel EM, Rockette HE, Kurs-Lasky M, Fall PA, Bluestone CD; International Journal of Pediatric Otorhinolaryngology (Oct 2009)
OBJECTIVE: To compare the efficacy of three surgical treatment combinations - myringotomy and tympanostomy tube insertion (M&T), adenoidectomy with M&T (A-M&T), and adenoidectomy with myringotomy (A-M) - in reducing middle-ear disease in young children with chronic OME. METHODS: Children 24-47 months of age, with a history of bilateral middle-ear effusion (MEE) for at least 3 months, unilateral for 6 months or longer or unilateral for 3 months after extrusion of a tympanostomy tube, unresponsive to recent antibiotic, were randomly assigned to either M&T, A-M&T, or A-M. Treatment assignment was stratified by age (24-35 months, 36-47 months), nasal obstruction (no, yes) and previous history of M&T (no, yes). Subjects were followed monthly and with any signs or symptoms of ear disease for up to 36 months. RESULTS: Ninety-eight subjects were randomly assigned to the three treatment groups. Fifty-six subjects (57%) were 24-35 months of age; 63% had nasal obstruction, and 36% had previously undergone M&T. During the 36 months after entry, subjects were noted to have MEE for the following percentages of time: 18.6% in the M&T group, 20.6% in the A-M&T group, and 31.1% in the A-M group (M&T vs. A-M&T, p=0.87; M&T vs. A-M, p=0.01). By 36 months, there were no differences in the number of further surgical procedures for ear disease needed among the groups. CONCLUSIONS: Adenoidectomy with or without tube insertion provided no advantage to young children with chronic OME in regard to time with effusion compared to tube insertion alone. Fewer tympanostomy tubes were placed in children undergoing A-M as their initial procedure, but this should be balanced by the performance of the more invasive surgical procedure and their increased time with effusion.