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Otorhinolaryngology News
Abreast Of Ear, Nose &
Throat / Head & Neck Advances
27 November, 2005
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Hello, All. You are Welcome
to this week's ORL Update. I do hope you find my picks
for this week exciting and useful |
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Biodun Olusesi,
Newsletter Editor |
Trans-corneal Viral transmission during
Mastoidectomy
You are carrying out conventional mastoidectomy
in a patient that was not screened for either HCV
or HIV. You are aware of possibility of bone
spicules getting at your cornea, but unaware that
patient-to-doctor transmission of potentially
fatal viruses may occur. Then you need to read the
report from Al Hilal et al (Laryngoscope.
115(10):1873-1876, October 2005)..
Abstract:
The incidence of chronic middle ear disease is
falling in Britain, and in adults, is currently
approximately 2.6% (inactive) and 1.5% (active).
The incidence of HIV and hepatitis C is, however,
rising. With this in mind, the chances of
operating on a patient with undiagnosed infection
is increasing. Operations involving the drilling
or cutting of bone in patients with bloodborne
communicable diseases are inherently dangerous to
surgeons. In the pre-antibiotic era, many
orthopaedic surgeons succumbed to infection and
septicemia after being pierced with a spicule of
bone during the execution of their duty. With the
advent of the antibiotic era, the phenomenon is no
longer life threatening where a bacterium is the
offending microorganism. The principle, however,
may be just as valid today with regard to viral
communicable diseases. The world medical
literature is full of reports of transmission of
HIV from doctor to patient or dentist to patient.
Very little is written about the reverse. This
study attempted to address the apparent imbalance
in the debate over exactly who is most at risk of
iatrogenic transmission of potentially lethal
viruses. We took fish eyes and held them in place
around a mastoid cavity during drilling of a
temporal bone. The eyes were then stained with
fluorescein and a blue light shone over them to
identify any spicules and corneal tears. Also,
during this study, the maximum distance of bone
dust scatter from an in vivo mastoid operation was
measured from the cavity in all directions and
documented. The HIV and hepatitis C virus are
discussed and the importance of protection to
staff highlighted. | |
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TOP PICKS
 Now
You can ear your stents...
How do you solve the riddle of irregular larynges - for
example post traumatic contusion / comminuted fracture
of laryngeal cartilages - vis-a-vis providing suitable
stent?
Heman-Ackah YD et al. recently provided a 'Why
haven't we thought that out' option in a recent
publication (Ann Otol Rhinol Laryngol 2005
Oct;114(10):739-42.)
Abstract: OBJECTIVES: Endolaryngeal stenting
in patients with irregularly shaped larynges can be
challenging. In such cases, the use of a moldable yet
reasonably rigid endolaryngeal stent is desirable. The
purpose of this report is to describe our experience
with silicone hearing aid material as a moldable
endolaryngeal stent in a patient with an atypically
shaped larynx. METHODS: A patient with relapsing
polychondritis that resulted in complete stenosis of the
subglottic airway underwent laryngotracheal
reconstruction. Moldable silicone, commonly used to
prepare ear canal molds for hearing aids, was molded
into the neo-endolarynx to serve as a custom-made
endolaryngeal stent. RESULTS: The patient tolerated the
moldable silicone stent well and had a patent airway
with epithelialization 8 months after removal.
CONCLUSIONS: Silicone mold material is a suitable
substance for endolaryngeal stenting. It conforms to the
configuration of the individual's airway, is tolerated
well, can be removed relatively easily, and is a useful
alternative to prefabricated stents in laryngotracheal
reconstruction.
New
Forum For Otolaryngologists in Africa...
A
new online forum has just being created to enable
Otolaryngologists in Africa share opinions, discuss
cases, and keep abreast of other global events
concerning the sciences and arts of otolaryngology. You
are cordially invited to be a member of this new group
designed to advance otolaryngology to the NEXT level.
Feel free to forward this information to other
Otolaryngologists known to you who might be interested
in being part of this event. To view this blogsite,
click
Here...
Should Brain MRI be made compulsory before Cochlear
Implant.....
The focus of pre-op and post-op imaging in Cochlear
Implantees has always been to ensure normal mastoid
size, middle ear status, Inner ear / 8th nerve, internal
auditory canal, 7th nerve course and anomaly a well as
the cochlear aqueduct. High resolution CT and high
resolution MRI have traditionally been employed for
these purpose. However, Lapointe A et al recently (Int J
Pediatr Otorhinolaryngol 2005 Nov 5) published a report
on CNS finding by MRI in children with profound
sensorineural hearing loss indicating that as much as
20% of such children showed significant brain
abnormalities by magnetic resonance imaging ranging from
myelination delays to migrational anomalies.
 Abstract:
INTRODUCTION: High-resolution magnetic resonance studies
are an important tool in the investigation of the
etiology of childhood sensorineural hearing loss. An
added benefit with magnetic resonance is the ability to
screen the central nervous system for findings which may
adversely affect the neurodevelopmental outcome of these
children. OBJECTIVE: To determine the proportion of
cases and significance of associated intracranial
abnormalities as detected by central nervous system
high-resolution magnetic resonance imaging in children
with profound sensorineural hearing loss. METHODS:
Retrospective chart review of children undergoing
evaluation for cochlear implantation in a tertiary care
academic children's hospital with high-resolution
magnetic resonance of the temporal bone and brain during
a 21 month period. Magnetic resonance studies were
interpreted by an experienced senior neuroradiologist
blinded to the identity and clinical data of the
patients. RESULTS: Forty patients
were identified. All had the same magnetic resonance
study consisting of a 3D high-resolution sequence
through the temporal bone as well as a T1 sagittal and
T2 axial screening sequence of the brain. Eight patients
(20%) showed significant brain abnormalities by magnetic
resonance imaging ranging from myelination delays to
migrational anomalies. Temporal bone abnormalities were
not seen. Three patients with Connexin-26 mutations had
no associated brain abnormalities by magnetic resonance.
CONCLUSIONS: A significant proportion of our patients
being investigated by magnetic resonance imaging for
profound sensorineural hearing loss show migrational
abnormalities of the central nervous system, suggesting
a central origin to their hearing loss. Some of these
findings may result in neurodevelopmental delay and
hence, negatively impact the success of
cochlear implantation. We propose that magnetic
resonance imaging of the
temporal bone as part of the evaluation protocol for
cochlear implantation
in children should include central nervous system
screening.
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CLINICAL PHOTO OF THE WEEK |
 A
12-year old male presented with swelling involving
the left half of the face since birth and recent
bilateral otalgia on chewing, and right nasal
obstruction. He has no other symptoms. Examination revealed the facial features
displayed on this picture, fullness of right
shoulder, and upper and lower limbs length
inequality with the left side slightly longer and
larger than the right
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What is the diagnosis?
Parting Shot...
If you have an interesting
case to discuss or share with other Otolaryngologists
all over Africa, feel free to email me or at best go to
otolaryngology in Africa blogsite
and post your case
Also, if you are among those who requested for a copy
of DODA at the last ORLSON Meeting @ Port Harcourt,
please take time to view the
DODA - FAQ page,
and expect your copy of the program soon
Till Next Week,
Biodun |
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© Copyright Dr 'Biodun
Olusesi,
2005 |
