AbstractObjectiveThis study aimed to compare the cost per use of video-rhinolaryngoscopy using reusable and disposable devices in a tertiary referral centre.MethodsA cost-comparison study was performed that utilised retrospective cost data and prospective utilisation data to compare the total costs of using reusable video-rhinolaryngoscopes versus a single-use alternative.ResultsIt was estimated that 4776 and 1821 procedures were performed annually with reusable and disposable video-rhinolaryngoscopes, respectively. The cost per use was £66.61 for reusable devices versus £150.00 for disposable devices. The break-even point (i.e. when cost per use was equal, occurred at 1374 procedures per year). Thereafter, it was cheaper to use reusable devices.ConclusionDisposable rhinolaryngoscopes may present a cheaper solution to services with low rates of rhinolaryngoscope utilisation. However, for larger services considering replacement of their reusable rhinolaryngoscopes with disposable units, it is likely that the recurring costs will be prohibitive in the medium to long term.

Diplopia is a common presenting complaint with a broad spectrum of differential diagnoses. Causative pathologies may affect the eye, extraocular muscles, neuromuscular junction, cranial nerves and central nervous system. Tumours, inflammatory and autoimmune conditions, vasculopathies and atypical infections are the most common underlying pathologies. Solitary extramedullary plasmacytoma is a rare cause of diplopia. This case emphasises the importance of submucosal biopsies for diagnosis and early involvement of the multidisciplinary team. Moreover, we advocate a low threshold for a second opinion and further immunohistochemistry, particularly when there is diagnostic uncertainty with histological discordance.

BACKGROUND:Pott's puffy tumour is a rare complication of sinusitis. This osteomyelitis can affect the outer and inner tables of the frontal sinus. The treatment of Pott's puffy tumour combines medical and surgical approaches. Surgical approaches have traditionally been open, but endoscopic techniques have been adopted recently in select cases. The bony defect from debridement can be left alone, or closed with autografts or allografts.OBJECTIVE:To describe a technique for the reconstruction of a large skull vault after the debridement of extensive osteomyelitis of the anterior cranial vault.METHODS:Modified distraction osteogenesis is used in the cranial vault, to induce new bone formation. This is customarily used to lengthen long bones. The advantages of this technique include avoiding autologous grafts or alloplastic cranioplasty in the infected surgical bed, and allowing primary closure.RESULTS:Early post-operative imaging results have been encouraging, with no reported complications.CONCLUSION:Modified distraction osteogenesis is a novel technique in the primary reconstruction of calvarial bone.

The treatment of post-surgical hypoparathyroidism (following thyroid or parathyroid surgery) is challenging. Presently, this condition is treated with calcium and vitamin D supplements rather than replacing the missing parathyroid hormone. Not only is it challenging to maintain normocalcaemia, but concerns of hypercalciuria and ectopic calcification have also been raised using these supplements. There is an ongoing debate whether recombinant parathyroid hormone (rPTH), which as yet is unlicensed for treating hypoPTH, may offer a more physiological solution. The objective of the study was to assess the effectiveness and safety of rPTH in maintaining normocalcaemia and normocalcuria in hypoparathyroidism. This was a systematic review performed using independently developed search strategies including Medline, Embase, CINAHL, Cochrane, Zetoc, conference proceedings and a manual search until 15 July 2014. Data extraction was undertaken by one reviewer (YR). Studies were synthesised through narrative review with tabulation of results. Of 2,141 studies identified, only eleven studies fitted the inclusion criteria. These studies suggest that rPTH is useful in normalising serum calcium levels. Excretion of urinary calcium levels is reduced with PTH 1–34 but remained unchanged in a number of studies using PTH 1–84. Recombinant PTH is well tolerated. The majority of studies included post-surgical hypoparathyroidism with marked heterogeneity. Further prospective, larger, long-term trials are necessary to evaluate the long-term efficacy and adverse profile of rPTH, including head to head comparisons between PTH 1–34 and PTH 1–84.

Background: Chronic rhinosinusitis is a common, heterogeneous condition. An effective means of mitigating disease in chronic rhinosinusitis patients remains elusive. A variety of causes have been implicated, with the biofilm theory gaining increasing prominence.Objective: This article reviews the literature on the role of biofilms in chronic rhinosinusitis, in terms of pathophysiology and with regard to avenues for future treatment.Methods: A systematic review of case series was performed using databases with independently developed search strategies, including Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, Cochrane library, and Zetoc, in addition to conference proceedings and a manual search of literature, with the last search conducted on 18 January 2014. The search terms included the following, used in various combinations to maximise the yield of articles identified: 'biofilms', 'chronic rhinosinusitis', 'DNase', 'extracellular DNA' and 'biofilm dispersal'.Results: The existing evidence lends further support for the role of biofilms (particularly the Staphylococcus aureus phenotype) in more severe, recalcitrant disease and poorer surgical outcomes.Conclusion: Multimodality treatment, with a shift in paradigm to incorporate anti-biofilm strategies, is likely to form the mainstay of future recalcitrant chronic rhinosinusitis management.

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OBJECTIVE:To investigate whether multiple-use Co-phenylcaine Forte® spray was more cost-effective than single-use vials.METHODS:A literature review was conducted to determine the risk of cross-contamination associated with multiple-use topical nasal anaesthetic spray. The costs of multiple-use Co-phenylcaine Forte and single-use co-phenylcaine were compared, and potential savings were calculated. The cost of procuring these drugs from other sources was also examined.RESULTS:Switching to multiple-use Co-phenylcaine Forte spray would lead to at least 40 per cent savings if bought from our local retailer. Potential savings of more than 70 per cent could be made if the drugs were procured from sources other than our local distributor.CONCLUSION:Multiple-use Co-phenylcaine Forte spray is safe to use and more cost-effective than single-use vials. This paper illustrates how money can be saved within the National Health Service through changes in drug procurement. Similar cost savings to those calculated for our department could be made in other ENT departments nationally, depending on their annual consumption of co-phenylcaine.

Objective: To investigate the utilisation of bone-anchored hearing aids and Softband, as well as the effects on quality of life, amongst the paediatric and young adult population of Freeman Hospital, Newcastle Upon Tyne, UK. Method: Retrospective, anonymised, cross-sectional survey using the Glasgow Benefit Inventory and Listening Situation Questionnaire (parent version), administered at least three months following the start of bone-anchored hearing aid or Softband use. Results: One hundred and nine patients were included, of whom syndromic children made up a significant proportion (22 of 109). Patients using bone-anchored hearing aids obtained significant educational and social benefit from their aids. The mean Listening Situation Questionnaire difficulty score was 17 (15 patients), which is below the trigger score of 22+ at which further reassessment and rehabilitation is required. 87% (of 15 patients) did not require further intervention. The overall mean GBI score for the 22 patients (syndromic and non-syndromic) was +29. Conclusion: The use of bone-anchored hearing aids and Softband results in significant improvements in quality of life for children and young adults with hearing impairment. There is significant under-utilisation of bone-anchored hearing aids in children with skull and congenital abnormalities, and we would advocate bone-anchored hearing aid implantation for these patients.

Neurogenic tumours of the larynx, particularly schwannomas are rare. We report a case report of a schwannoma in a 30-year-old woman which was excised endoscopically. The aim of this paper is to highlight this rare condition and management options to the otolaryngological community.

Computed tomography scans serve as a critical 'roadmap' for functional endoscopic sinus surgery. A systematic evaluation of such scans, and an awareness of any anatomical variants that may modify one's surgical approach, allow one to pre-empt complications. This article describes, from a novice's perspective, two methods of evaluating paranasal sinus computed tomography scans: a quick assessment technique; and a step-wise, operative approach covering radiological features relevant to pre- and peri-operative management.

BACKGROUND:An understanding of the management of chronic facial palsy is vital for otolaryngologists, due to its common presentation to ENT surgeons. There is currently a lack of consensus on the optimum management of this condition. This article reviews the existing literature and offers a perspective on current management, as well as an insight into future treatments.METHODS:A literature search was performed, using the Medline, Embase and Cochrane databases from 1966 to the present, using the keywords listed below. Articles were reviewed. Selection was limited to English language articles on human subjects.RESULTS AND CONCLUSION:A tailored, multidisciplinary approach using combinatorial therapy should be used for reanimation of the face following facial palsy. Advances in surgical and non-surgical techniques, and the exchange of information from centres of excellence via global databases, will enable objective appraisal of results and the development of an evidence-based approach to facial reanimation.

Background: A clinical investigation was performed into the practicalities of the collection of blood samples for the determination of drug exposures on filter paper, known as dried blood spot (DBS) sampling using a two-period, single-dose, open-label trial conducted in 11 healthy volunteers who received a single oral dose of paracetamol. Questionnaires relating to the blood sampling and spotting process and tolerability were completed by staff and volunteers. Paracetamol concentrations in DBS samples obtained by venous cannula (DBS-Can) were compared against those from fingerprick (DBS-FP) and fresh whole blood obtained from a cannula (WB-Can). Results: The questionnaires demonstrated that FP and blood spotting was easy to perform and well tolerated and compared favorably with cannula sampling. Paracetamol concentrations in DBS-Can were greater than those in WB-Can (positive bias) except below 8000 ng/ml when both were interchangeable. When comparing DBS-FP to DBS-Can, both the bias and variability differed significantly across the five sampling time points. Conclusion: The study has shown that the DBS technique is practical in the context of a clinical trial. Interchangeability of drug concentrations between blood sampling site and mode of blood collection has to be checked and taken into account when designing pharmacokinetic studies for other compounds.

European Journal of PainVolume 13, Issue S1 p. S121-S121 400 THE EFFECTS OF PARACETAMOL AND THE NK1 ANTAGONIST APREPITANT ON THE UVB-EVOKED CUTANEOUS HYPERALGESIA IN HEALTHY VOLUNTEERS Y. Boyle, Y. Boyle GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this authorD. Robertson, D. Robertson GlaxoSmithKline, Cambridge, United Kingdom Department of Physiology and Pharmacology, School of Medical Sciences, University of Bristol, Bristol, United KingdomSearch for more papers by this authorM. O' Donnell, M. O' Donnell GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this authorL. Griffiths, L. Griffiths GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this authorD. Hewens, D. Hewens GlaxoSmithKline, Discovery Biometrics, New Frontiers Science Park, Harlow, Essex, United KingdomSearch for more papers by this authorL. Cookson, L. Cookson GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this authorY. Ramakrishnan, Y. Ramakrishnan GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this authorB. Chizh, B. Chizh GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this author Y. Boyle, Y. Boyle GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this authorD. Robertson, D. Robertson GlaxoSmithKline, Cambridge, United Kingdom Department of Physiology and Pharmacology, School of Medical Sciences, University of Bristol, Bristol, United KingdomSearch for more papers by this authorM. O' Donnell, M. O' Donnell GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this authorL. Griffiths, L. Griffiths GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this authorD. Hewens, D. Hewens GlaxoSmithKline, Discovery Biometrics, New Frontiers Science Park, Harlow, Essex, United KingdomSearch for more papers by this authorL. Cookson, L. Cookson GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this authorY. Ramakrishnan, Y. Ramakrishnan GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this authorB. Chizh, B. Chizh GlaxoSmithKline, Cambridge, United KingdomSearch for more papers by this author First published: 12 January 2012 https://doi.org/10.1016/S1090-3801(09)60403-1Read 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 onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume13, IssueS1September 2009Pages S121-S121 RelatedInformation

European Journal of PainVolume 13, Issue S1 p. S123a-S123 408 A PILOT STUDY OF MARKERS OF PERIPHERAL AFFERENT ACTIVATION AND NEUROGENIC INFLAMMATION IN THE ELECTRICAL HYPERALGESIA MODEL USING MICRODIALYSIS D. Robertson, D. Robertson GSK/University of Bristol, Cambridge, United KingdomSearch for more papers by this authorM. O'Donnell, M. O'Donnell GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this authorY. Boyle, Y. Boyle GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this authorL. Smith, L. Smith GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this authorJ. Robertson, J. Robertson GSK, New Frontiers Science Park, Harlow, United KingdomSearch for more papers by this authorY. Ramakrishnan, Y. Ramakrishnan GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this authorL. Cookson, L. Cookson GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this authorB. Chizh, B. Chizh GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this author D. Robertson, D. Robertson GSK/University of Bristol, Cambridge, United KingdomSearch for more papers by this authorM. O'Donnell, M. O'Donnell GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this authorY. Boyle, Y. Boyle GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this authorL. Smith, L. Smith GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this authorJ. Robertson, J. Robertson GSK, New Frontiers Science Park, Harlow, United KingdomSearch for more papers by this authorY. Ramakrishnan, Y. Ramakrishnan GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this authorL. Cookson, L. Cookson GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this authorB. Chizh, B. Chizh GSK, ACCI, Addenbrooke's Hospital, Cambridge, United KingdomSearch for more papers by this author First published: 12 January 2012 https://doi.org/10.1016/S1090-3801(09)60411-0Read 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. Volume13, IssueS1September 2009Pages S123a-S123 RelatedInformation

Retraction pockets can lead to hearing loss and cholesteatoma. Distinguishing stable from progressive disease is challenging to any otologist. The management of retraction pockets is a contentious issue with present treatment options often plagued with recurrence. The purpose of this article is to summarize recent developments in the aetiology of retraction pockets of the pars tensa, its diagnostic and management problems and to define possible future therapeutic options.

The European Working Time Directive (EWTD) was enacted in UK law in October 1998, as the working time regulations (WTR) describing minimum working requirements for all employees. Although doctors in training were initially excluded, the WTR were extended in August 2004 to include this group.

Objectives: Comorbidity has been shown to be a determinant in treatment selection and survival in squamous cell cancer of the head and neck at various subsites. The objective of this study is to analyse the effect of comorbidity burden on outcome of nasopharyngeal cancer using the Adult Comorbidity Evaluation-27 (ACE-27) instrument.Design: Retrospective analysis.Setting: Tertiary care centres.Participants: This study included 59 patients diagnosed with nasopharyngeal carcinoma between 1989-2003 in the North-East of England. Exclusion criteria included non-squamous neoplasms of the nasopharynx. Comorbidity was assessed retrospectively from the notes using standard validated techniques described earlier. Tumour, treatment and survival data were obtained from prospective databases. Data was analysed using SPSS for Windows.Main outcome measures: Comorbidity and outcome of treatment.Results:Comorbid burden was evident in 44% of patients, with moderate or severe comorbidity in 19%. The cardiovascular system was the most commonly affected system (27%). Cox's proportional hazard model showed age and stage of tumour to have an impact on disease specific survival. Comorbidity was not seen to predict the outcome independent of other factors. The sample size of this study is powered to detect only medium to large effects. We estimate that 614 subjects will be needed to detect a correlation coefficient of 0.1 with 80% power, assuming a type 1 error rate of 5%.Conclusion: This study shows for the first time that the comorbidity burden seen in nasopharyngeal cancer does not affect prognosis independent of the TNM staging.

Background: The diagnosis and management of olfactory disorders is an often neglected topic in otolaryngology. This article evaluates current clinical practice within the United Kingdom, and provides a literature-based review of the diagnosis, management and prognosis of olfactory pathology. Design: A questionnaire was sent to consultant and associate specialist members of the British Association of Otolaryngologists and Head and Neck Surgeons. The responses were documented to gain an impression of how olfactory disorders are managed in the United Kingdom. The literature relating to olfactory dysfunction was then evaluated and the findings summarised. Conclusions: Management of olfactory pathology varies across the United Kingdom. The literature suggests that chemosensory testing is optimal and that both forced-choice and threshold testing should be applied if objective evaluation is required. Imaging can be of value but the appropriate technique should be used. Olfactory function can recover following head injury, viral infection and chronic sinonasal disease, although varying degrees of dysfunction are likely to persist. There is a role for the use of corticosteroids, particularly when administered systemically. More research is needed to establish the appropriate dose and length of treatment.