Issues for Men Working with Sexually Abused Children

This paper outlines some issues facing men who work with children who have been sexually abused. It is argued that there is an intrinsic connection between child sexual abuse and masculine sexuality. Working with abused children faces men with our own potentially abusive tendencies. To some extent commitment to child sexual abuse work can be understood as a response to this situation expressing, for example, reaction formations or reparative urges. Two case examples are given to demonstrate the importance of recognition of these factors and the way such recognition may contribute to therapeutic utilisation of transference and counter-transference emotions.     

Is local anaesthesia actually beneficial in flexible fibreoptic nasendoscopy?

Although the application of a topical local anaesthetic before fibreoptic nasendoscopy is routine practice in many otolaryngological outpatients, the actual benefit to the patient of this procedure remains in doubt. Eighty-two patients were recruited in this double-blind randomized control trial which compared the patients’ experiences of fibreoptic nasendoscopy with nasal preparations of Xylocaine^® (lidocaine), normal saline, and no spray to the nose and throat. A visual analogue scoring system was used to determine scores for the overall unpleasantness of procedure, receiving a spray, and taste of the spray, and pain. This study has shown significantly worse overall experience (P = 0.001) and pain (P = 0.048) scores for Xylocaine^® spray versus no spray. It is concluded that the routine use of topical local anaesthetics within the nose before routine fibreoptic nasendoscopy is not only of no value, but actually makes the experience worse for the patient.     

Prions and the ENT surgeon

Recent developments in our understanding of prion diseases have raised concerns for the public health. There is now compelling evidence that the transmissible agent for variant Creutzfeldt-Jakob disease (vCJD) in affected individuals is accumulated in lymphoreticular tissues such as the appendix and tonsils. This agent demonstrates a remarkable resistance to standard methods of sterilisation used in hospital sterile services departments. The possible implications this has on the safety of surgical instruments in ENT and other surgical practice is discussed. This review also outlines the history of our understanding of prion diseases and describes the development of a diagnostic test for vCJD in the living patient by pharyngeal tonsil biopsy.     

Silver nitrate: histological effects of cautery on epithelial surfaces with varying contact times

Silver nitrate is used extensively in rhinological practice for the treatment of recurrent epistaxis. There are currently no recommendations in the literature regarding the optimum application time of this chemical for effective treatment. We assessed the histological effects of silver nitrate on mucosal tissue at varying contact times and made recommendations based on our findings. Silver nitrate was applied at predetermined contact times to tonsillar mucosa, immediately before tonsillectomy in subjects undergoing routine surgery. The cauterized areas were subsequently analysed histologically. The depth of tissue penetration by the silver nitrate was measured. The means for 5, 10 and 20 s were 0.44, 0.30 and 0.38, respectively, P = 0.3. Overall, there was no deeper penetration of the tissues with contact times over 5 s. We conclude that it is not necessary to apply silver nitrate for greater than 5 s to achieve maximal tissue penetration.     

SENSORINEURAL HEARING LOSS IN LINEAR IgA DISEASE

A 23-year-old female with progressive sensorineural hearing loss developed widespread blistering eruptions while under evaluation for the hearing loss. The lesions showed findings characteristic of linear IgA disease (LAD) on histochemical studies. Linear IgA disease is a dapsone responsive autoimmune subepidermal blistering disease characterised by linear IgA deposits in the basement membrane zone. The complete spectrum of this systemic disease is still not clear and this is the first report of association between LAD and sensorineural deafness.     

The Foley catheter in the management of epistaxis

The Foley urinary catheter has been used in the management of epistaxis for many years, yet it has never been designed or licensed for this purpose. We performed a telephone questionnaire of senior house officers in 90 ENT departments in England and Wales. The aim was to determine how many departments used the Foley catheter for epistaxis management, whether licensed nasal balloon devices were available and if there had been any complications associated with their use. Eighty-three (92%) ENT departments in the study used the Foley catheter for epistaxis management and 44 (49%) departments had licensed balloon devices available. Only 22% of ENT senior house officers questioned were aware that the Foley catheter was not licensed for use in the nose. Most complications associated with the use of nasal balloon devices appear to be due to Foley catheters.     

Analysis of 2000 consecutive UK tonsillectomy specimens for disease-related prion protein

Variant Creutzfeldt-Jakob disease (CJD) is thought to be caused by dietary or other exposure to bovine spongiform encephalopathy (BSE) prions. The prevalence of preclinical or subclinical prion infection in the UK is currently unknown. Since clinical variant CJD is uniformly associated with tonsillar prion infection, we screened 2000 anonymous surgical tonsillectomy specimens for disease-associated prion protein. Analysis by both high sensitivity immunoblotting and immunohistochemistry detected no positive cases. However, this negative result cannot provide reassurance that relevant community infection is unlikely because of the fairly small sample size, demographic and age-related factors, and unknown test sensitivity during the prolonged incubation period. Nevertheless, our findings establish a protocol for prevalence screening on a national scale.     

Effect of chewing gum on recovery after tonsillectomy

OBJECTIVE: Patients are traditionally advised to eat early and frequently in the initial post-tonsillectomy period to reduce the severity of pain and to facilitate early resumption to a normal diet. We investigated the action of mastication and therefore the promotion of saliva formation and deglutition on the post-operative recovery of tonsillectomy patients. METHODS: We present a prospective randomised controlled trial set up to observe the effects of chewing gum on these patients. One hundred and two patients undergoing routine tonsillectomy for recurrent tonsillitis were randomised into cases (those given chewing-gum) and control groups (those not given chewing-gum). Eighty-four patients were reviewed on the seventh post-operative day. We measured the time taken in days for the subjects to resume to their normal diet after surgery and measured pain on a daily basis. RESULTS: Our study demonstrated that chewing gum in the early post-operative period significantly delayed resumption of normal diet (Chi-squared test with Yates' correction, chi2= 4.6, P = 0.032). Chewing gum also increased the average amount of pain experienced by the cases over the controls and this became statistically significant on day 7 (mean difference = 14.8, t-test with two tailed probability, P = 0.041). CONCLUSION: We conclude that chewing gum should not be routinely advised in the early period following tonsillectomy.