Background The Internet hosts a large number of high-quality medical resources and poses seemingly endless opportunities to inform, teach, and connect professionals and patients alike. However, it is difficult for the lay person to distinguish accurate from inaccurate information. Aim This study was undertaken in an attempt to assess the quality of information on otolaryngology available on the Internet. Methods Sixty appropriate websites, using search engines Yahoo and Google, were evaluated for completeness and accuracy using three commonly performed ENT operations: tonsillectomy (T), septoplasty (S), and myringoplasty (M). Results A total of 60 websites were evaluated (NT = 20, NM = 20, NS = 20). A total of 86.7% targeted lay population and 13.3% targeted the medical professionals. 35% of the sites included all critical information that patients should know prior to undergoing surgery and over 94% of these were found to contain no inaccuracies. Negative bias towards medical profession was detected in 3% of websites. Conclusions In the current climate, with informed consent being of profound importance, the Internet represents a useful tool for both patients and surgeons.

Choanal atresia is a rare malformation, affecting 8:100,000 births. While bilateral choanal atresia usually needs to be surgically treated within a few days of birth, the intervention for unilateral choanal atresia should be delayed until at least 6 months of age, whenever possible. Treatment planning requires adequate imaging by CT or MRI. Transnasal endoscopic repair is the preferred technique for the surgical treatment of choanal atresia.

Clinical OtolaryngologyVolume 33, Issue 2 p. 153-153 Response to Dhiwakar and McKerrow B.G. Fennessy, B.G. Fennessy Department of Otorhinolaryngology, The Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland.E-mail: brendanfennessy@yahoo.comSearch for more papers by this authorM. Harney, M. Harney Department of Otorhinolaryngology, The Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland.E-mail: brendanfennessy@yahoo.comSearch for more papers by this authorM.J. O’Sullivan, M.J. O’Sullivan Department of Otorhinolaryngology, The Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland.E-mail: brendanfennessy@yahoo.comSearch for more papers by this authorC. Timon, C. Timon Department of Otorhinolaryngology, The Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland.E-mail: brendanfennessy@yahoo.comSearch for more papers by this author B.G. Fennessy, B.G. Fennessy Department of Otorhinolaryngology, The Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland.E-mail: brendanfennessy@yahoo.comSearch for more papers by this authorM. Harney, M. Harney Department of Otorhinolaryngology, The Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland.E-mail: brendanfennessy@yahoo.comSearch for more papers by this authorM.J. O’Sullivan, M.J. O’Sullivan Department of Otorhinolaryngology, The Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland.E-mail: brendanfennessy@yahoo.comSearch for more papers by this authorC. Timon, C. Timon Department of Otorhinolaryngology, The Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland.E-mail: brendanfennessy@yahoo.comSearch for more papers by this author First published: 18 April 2008 https://doi.org/10.1111/j.1749-4486.2008.01651.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume33, Issue2April 2008Pages 153-153 RelatedInformation

Effective canal wall down mastoid surgery requires attention to certain key principles. We reviewed all cases requiring revision surgery at the Royal Victoria Eye and Ear Hospital over a 6 year period 1999-2004. Intraoperative findings which contributed to the need for revision surgery were identified. During this 6 year period 291 canal wall down mastoidectomies were performed. Thirty-seven were revision procedures. Nineteen (51%) cases were found to have recurrent or residual cholesteatoma. Sixteen (43%) cases had a high facial ridge, thirteen (35%) cases had an open middle ear. Nine (24%) cases had an inadequate meatus, 2 (5%) cases had a cavity sump. This study illustrated that a high facial ridge, an open middle ear segment, an inadequate meatoplasty and recurrent cholesteatoma were common intraoperative findings in this revision group. Eighty-nine percent of revision cases had dry, healed and safe cavities on follow up. Poor performance of the open technique is the most important factor in failure.

Objectives: Allergic fungal sinusitis (AFS) may represent an endpoint in a spectrum of sinonasal disease. Patients fulfilling criteria for a diagnosis of AFS have a poor prognosis often requiring multiple surgeries. The detection of 'allergic mucin' with mucus containing clusters of eosinophils and the detection of fungi by histological examination or culture is key criteria necessary for diagnosis.This study was performed to assess the strength of the association of the presence of fungi with the presence of eosinophils in a group of patients with chronic rhinosinusitis and controls.Methods: Thirty patients with a clinical diagnosis of chronic rhinosinusitis and 10 individuals as control group were selected for the study. Total serum IgE level testing, nasal mucus cytology and fungal culture were performed in all subjects.Results: Fungal spores were present in the nasal mucus in 14 patients with rhinosinusitis, and in 7 controls. The detection of eosirrophils on cytology correlated significantly both with a clinical diagnosis of chronic rhinosinusitis (95% confidence intervals (CI) 0.34-0.81) and with the presence of fungal elements on cytology (p = 0.02). The average serum IgE level was higher in patients with fungal spores (p = 0.039).Conclusion: In certain susceptible individuals inhaled fungi may provoke an eosinophilic response. This response varies from simple eosinophilic inflammation to classic allergic fungal sinusitis. (c) 2006 Elsevier Ireland Ltd. All rights reserved.

Prophylactic antimicrobial therapy is defined as the administration of an antimicrobial agent prior to contamination of previously sterile tissues or fluids, in an attempt to reduce the microbial burden of intraoperative contamination. Prophylactic antimicrobial therapy should cover the anticipated floral contamination, with therapeutic levels from incision to closure. There is level I evidence to support the use of prophylaxis in clean-contaminated head and neck procedures and tonsillectomy, while level II evidence fails to support the use of prophylaxis in clean head and neck procedures. The aim of this study was to evaluate the use, timing and appropriateness of antimicrobial prophylaxis perioperatively, in otorhinolaryngological/head and neck procedures. A total of 34/51 (66%) patients were administered antimicrobial agents prophylactically. Six of 19 patients (42%) who ought to have received prophylaxis did not, while six of 13 (46%) of those who did not require it received it. Administration was unsuitably timed in 14 of 34 (41%) operations. This study demonstrates unnecessary administration of antimicrobial agents perioperatively, subclinical intraoperative antimicrobial levels for prophylaxis and inconsistent documentation regarding prophylaxis in otorhinolaryngological/head and neck procedures in a general ENT unit.

Summary: Purpose: Familial periventricular heterotopia (PH) represents a disorder of neuronal migration resulting in multiple gray‐matter nodules along the lateral ventricular walls. Prior studies have shown that mutations in the filamin A ( FLNA ) gene can cause PH through an X‐linked dominant pattern. Heterozygotic female patients usually remain asymptomatic until the second or third decade of life, when they may have predominantly focal seizures, whereas hemizygotic male fetuses typically die in utero. Recent studies have also reported mutations in FLNA in male patients with PH who are cognitively normal. We describe PH in three male siblings with PH due to FLNA , severe developmental regression, and West syndrome. Methods: The study includes the three affected brothers and their parents. Video‐EEG recordings and magnetic resonance image (MRI) scanning were performed on all individuals. Mutations for FLNA were detected by using polymerase chain reaction (PCR) on genomic DNA followed by single‐stranded conformational polymorphism (SSCP) analysis or sequencing. Results: Two of the siblings are monozygotic twins, and all had West syndrome with hypsarrthymia on EEG. MRI of the brain revealed periventricular nodules of cerebral gray‐matter intensity, typical for PH. Mutational analyses demonstrated a cytosine‐to‐thymidine missense mutation (c. C1286T), resulting in a threonine‐to‐methionine amino acid substitution in exon 9 of the FLNA gene. Conclusions: The association between PH and West syndrome, to our knowledge, has not been previously reported. Males with PH have been known to harbor FLNA mutations, although uniformly, they either show early lethality or survive and have a normal intellect. The current studies show that FLNA mutations can cause periventricular heterotopia, developmental regression, and West syndrome in male patients, suggesting that this type of FLNA mutation may contribute to severe neurologic deficits.

Surveillance for Creutzfeldt-Jakob disease (CJD) has been carried out in the Republic of Ireland since 1980. Initial surveillance was passive and based on consented autopsy confirmation of CJD in patients in whom there was a high index of clinical suspicion. Since 1999, an active surveillance programme involving formal notification of all suspect CJD cases has been in place. The annual mortality rate has increased from 0.34 cases/million in 1980 to 1.27 cases/million in 2001. In all, 29 cases have been pathologically confirmed: 1 had variant CJD (vCJD), 1 had iatrogenic human growth hormone-induced CJD and 1 had fatal insomnia. Sporadic CJD (sCJD) accounted for the remainder. This paper details the change in incidence over 22 years as the surveillance programme in Ireland got under way; the increased incidence is attributed to better case ascertainment, as has occurred in other countries where active surveillance programmes have been established.

This article describes the technique of manipulation of nasal bones under local anaesthesia. With increased demand on day ward and in patient hospital beds there is a growing need to treat fractured nasal bones under local anaesthesia at the ENT clinic. Ten patients were treated in this fashion in the out patient setting. All had X rays confirming a fracture of the nasal bones. All ten had an obvious cosmetic deformity of the nose as a result of the fracture. All ten patients underwent satisfactory reduction under local anaesthesia and without the need for intra nasal manipulation to elevate overlapping bones. Reduction of nasal bones in the clinic under local anaesthesia should become the accepted practice where there is a deformity but no overlap of the nasal bones.

BACKGROUND:Excision of parotid superficial lobe pleomorphic adenomas requires removal of a surrounding cuff of normal parotid tissue. Less aggressive dissection in removing pleomorphic adenomas that occur in the deep lobe of the parotid gland does not seem to compromise prognosis in these patients. We attempted to define histologic characteristics, differentiating superficial and deep lobe tumors, in an attempt to explain this clinical phenomenon. METHOD:Thirty-one pleomorphic adenomas, 12 deep-lobe tumors, and 19 superficial lobe tumors were analyzed and compared, looking at tumor size, capsule thickness, penetration of tumor through capsule, and predominant cell types present. RESULTS:The superficial lobe tumors had significantly thinner capsules (p =.02). There was increased extracapsular extension of tumor in the superficial lobe group compared with the deep lobe group (79% and 58%, respectively). The tumors were larger in patients with deep lobe lesions (2.6 cm vs 3.6 cm). There was no difference in predominant cell types. CONCLUSIONS:The anatomic location of deep lobe tumors is a likely explanation for the histologic differences observed in this study. These important differences allow less aggressive dissection in deep lobe tumors without compromising prognosis.

Background: The Republic of Ireland has the second highest incidence of BSE worldwide. Only a single case of vCJD has been identified to date.Methods: We estimate the total future number of clinical cases of vCJD using an established mathematical model, and based on infectivity of bovine tissue calculated from UK data and on the relative exposure to BSE contaminated meat.Results: We estimate 1 future clinical case ( 95% CI 0 - 15) of vCJD in the Republic of Ireland. Irish exposure is from BSE infected indigenous beef products and from imported UK beef products. Additionally, 2.5% of the Irish population was exposed to UK beef through residing in the UK during the ' at- risk' period. The relative proportion of risk attributable to each of these three exposures individually is 2: 2: 1 respectively.Conclusions: The low numbers of future vCJD cases estimated in this study is reassuring for the Irish population and for other countries with a similar level of BSE exposure.

One hundred and eight parotidectomies performed by a single consultant were reviewed. Eighty-five patients had primary parotid disease, 23 patients had extra-parotid primaries. Pleomorphic adenoma was the most common histological diagnosis. In patients with primary parotid disease, a post-operative temporary facial nerve palsy was noted in 15 patients, with a further four developing a permanent palsy. Patients with metastatic disease to the parotid had a poor prognosis.

We present a case report of a lady with a laryngocele and a squamous cell carcinoma of the larynx. The pathogenesis of the relationship between these two entities is discussed and the literature reviewed. This association means a carcinoma must be outruled if a laryngocele is detected clinically or radiologically.