Benign positional paroxysmal vertigo in the general ear, nose, and throat clinic

Benign positional paroxysmal vertigo is a common disease which may be caused by abnormal movement of utricular debris in the posterior semicircular canal. It is diagnosed by the Dix-Hallpike positional maneuver eliciting vertigo and nystagmus. Treatment generally consists of physical exercises with the Epley or Semont maneuvers. We review 43 consecutive patients diagnosed as BPPV in the last year and treated with physical therapy (Epley maneuvers). Results were very good, with a cure rate of 88.37% (53.5% after a single maneuver). Physical therapy is an effective treatment for BPPV.     

Major outpatient surgery in the ear, nose and throat clinic

In recent years, outpatient surgery in otolaryngology has advanced because it benefits both patients and health-care systems. We analyzed the surgical procedures that can be performed in outpatient surgery programs, evaluating patient selection, release criteria, and potential complications. A one-year retrospective study was made of 456 patients, of which 369 (80.92%) were discharged from the hospital on the same day as surgery. The operations with the best performance in outpatient surgery were adenoidectomy, tonsillectomy, laryngeal microsurgery, and septoplasty. Most surgical procedures in otolaryngology can be performed without hospitalization. Outpatient surgery is easier for patients and increases their sense of safety. It also has an excellent cost-benefit relation for health-care systems.     

Eye protection in ear, nose and throat surgery

The aim of this study was to quantify the risk of blood splashes to the conjunctiva during ear, nose and throat surgery. Two hundred and sixty consecutive operations by three surgeons were assessed for contamination of safety glasses and other factors. We found that 15 per cent of operations resulted in blood droplet contamination of safety glasses. In 92 per cent of these, contaminations were on the exterior of the glasses and eight per cent were on both sides. We concluded that about one and a half per cent of operations would result in droplet contamination of the conjunctiva and that safety spectacles reduced the risk by a factor of about 10. This study generally concurs with that of previous research in the areas of general and orthopaedic surgery and necropsies. We substantiate the need for eye protection for all ear, nose and throat procedures. Spectacles do provide a reasonable degree of protection but where absolute protection is needed i.e. in high risk groups, goggles should be used in preference to safety spectacles.     

Informed consent in ear, nose and throat practice

Changes in society's mentality have made health professionals get involved in legal aspects. In order to perform a correct medical proceeding, two premises must be fulfilled (Spanish Health General Law, 25th April 1986). First that it is carried out according to lex artis and second patient's consent. Consent needs as a prerequisite the adequate information; it is temporal, it can be revoked and it must be freely given and in writing (although it can be guaranteed by other means). Consent includes, on the patient's side, his/her acceptance of those risks inherent to the treatment. Nevertheless, it does not assure its results since doctor-patient's agreement is just related to means. If it were necessary, it is the doctor the one responsible to prove the consent was appropriately given. This would not be necessary when there is any kind of risk for public health or when the urgency allows no delay. Likewise, the assumption of the patient being under age or not able to take any decision will also be analysed. Features to be fulfilled by informed consent models are also analysed and a prototype is proposed.     

Robotic surgery in ear nose and throat

The arrival of a commercial surgical robotic platform at our institution has raised the question of its application and usefulness within the department of otolaryngology head and neck surgery. In order to answer this question, we sought to perform a qualitative review to examine the evolution of commercial surgical robotics and examine present and future applications of this emerging technology within our specialty. The main objective of this study is to examine the development and application of robotic surgery in otolaryngology, head and neck surgery. The study includes a qualitative systematic review. We have reviewed research papers and studies that specifically relate to the use of robots in otorhinolaryngology. More specifically, we have attempted to review those studies that have significantly added to the development of this field. In summary, we have examined eight animal studies, six cadaveric studies, nine human trials. Robotic surgery in ENT is a safe and feasible option. In certain procedures, it offers significant benefits over conventional surgery. Instrument and robotic arm size, and costs are limiting factors that prevent the use of robots being applied to many additional ENT procedures. We feel the development of new speciality-specific robots will yield a new era in the common use of robotics in ENT.     

Castleman's disease in ear, nose, and throat practice

Castleman's disease, also called angiofollicular lymph node hyperplasia or benign giant lymphoma, is a rare lymphoproliferative disorder of unknown etiology. Three histologic subtypes are described--hyaline vascular (80-90%), plasma cell (10-20%), and mixed (rare). In the clinical setting, localized and multicentric entities are distinguished. Due to the lack of tumor-specific clinical, biochemical, and radiological features, final diagnosis of Castleman's disease depends on histopathology. Surgical tumor resection is the treatment of choice for localized disease. Prognosis is good, and adjuvant therapy is not required. Therefore, early invasive removal and histopathological differentiation from neoplasia is mandatory. In contrast, the prognosis for multicentric Castleman's disease remains poor even if multimodal treatment regimens are employed. Major clinical symptoms, histology, and therapy are summarized, and the disease characteristics are highlighted presenting the case of an 11-year-old girl. On admission, the patient complained of a painless pharyngeal tumor mass and ipsilateral lymph node swelling. Magnetic resonance imaging revealed a parapharyngeal contrast-enhancing lesion extending from the hypopharynx to the skull base without signs of infiltration and accompanied by ipsilateral lymph node hyperplasia of the neck. Laboratory test results were within normal limits. After tumor resection, histopathological examination, and clinical staging, localized Castleman's disease was diagnosed (hyaline vascular subtype).     

Endoscopic photography of the ear,nose, and throat

The ability to view and photograph the ears, nose, nasopharynx, hypopharynx, and larynx has been revolutionized by the advent of the flexible fiberoptic nasopharyngolaryngoscope. For the first time the otolaryngologist has a one-instrument capability for examination and photodocumentation of the structures with which the specialty deals. This should not imply that the conventional means of examination should be relegated to museums, but rather that a new instrument has been added to the diagnostic armamentarium. The real visual images may be readily adapted for photography. The author will detail a straightforward and inexpensive method for obtaining high quality color transparencies, and color and sound video tapes.     

Child abuse within the ear, nose and throat

Non-accidental injuries to the ear, nose and throat are inevitably difficult to detect because of their covert nature. A survey of 50 hospitals and all NSPCC child abuse units in England was carried out to determine the type of injuries that were inflicted to these regions in verified cases of abuse. The importance of detecting these injuries is emphasized to permit intervention and prevent escalation of injury.