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Journal 2016 Journal of ENT masterclass ISSN 2047-959X Journal of ENT MASTERCLASS® Journal of Journal ENT MASTERCLASS ® VOL: 9 No: 1 Year Book 2016 Volume 9 Number 1 YEAR BOOK 2016 VOLUME 9 NUMBER 1 JOURNAL OF ENT MASTERCLASS® Volume 9 Issue 1 December 2016 TriVantage | APS | NIM 3.0 Contents Welcome message 3 Hesham Saleh Confidence Intracranial complications of suppurative ear disease 4 James E.F. Howard and Matthew S. Rollin The large vestibular aqueduct syndrome 9 Security Cheka. R. Spencer Management of sudden sensorineural hearing loss 13 Safety Stephen J Broomfi eld Patulous eustachian tube 19 Sam MacKeith and Ian Bottrill Principles of facial reanimation 24 Ahmed Allam and Glen J. Watson A multidisciplinary approach to the management of paediatric drooling 29 C Paul and A Addison Extra-uterine intrapartum treatment (EXIT) and upper airway obstruction of the newborn 34 Colin R Butler, Elizabeth F Maughan and Richard Hewitt The management of paediatric facial nerve palsy 41 Sachin Patil, Neeraj Bhangu, Kate Pryde and Andrea Burgess Paediatric sleep physiology and sleep disordered breathing 50 Gahleitner F, Hill CM and Evans HJ Paediatric tracheostomy 57 Morad Faoury, Andrea Burgess and Hasnaa Ismail-Koch Paediatric vocal cord paralysis 64 Virginia Fancello, Matthew Ward, Hasnaa Ismail-Koch and Kate Heathcote Transoral laser surgery for advanced laryngeal cancer 69 Isabel Vilaseca and Manuel Bernal-Sprekelsen Open partial surgery for primary and recurrent laryngeal cancer 75 Giuseppe Spriano, Giuseppe Rizzotto, Andy Bertolin, Giuseppe Mercante, Antonio Schindler, Erika Crosetti, and Giovanni Succo Management of professional voice problems 83 A.S Takhar, R. Awad, A. Aymat and N. Gibbins Innovating for life. UC201403300EE 1 JOURNAL OF ENT MASTERCLASS® YEAR BOOK 2016 VOLUME 9 NUMBER 1 JOURNAL OF ENT MASTERCLASS® Welcome to Volume 9 Issue 1 of Journal of ENT Masterclass® 2016 Management of head and neck sarcoma 90 This volume arrives in my second year as the Chairman of the Editorial Justin CL Yeo, Iain J. Nixon and Ioanna Nixon Board of the Journal of ENT Masterclass®. Taking this role last year made me realise the magnitude of hard work that had been taken in the past Transoral endoscopic ultrasonic surgery (TOUSS) years and I am very pleased that we have continued with the previous as an alternative to TORS. 97 successes. The 8th Journal of ENT Masterclass® was very well received Mario M Fernández-Fernández, Francesc X Avilés, Editor: by the ENT fraternity in UK and the free subscription has been extended Lourdes Montes-Jovellar and Marc Tobed Mr. M S Quraishi to all the members of ENT-UK following its official accreditation by our FRCS, FRCS (ORL, H&N) national body. Consultant ENT Surgeon Management of occult primary in head and neck 103 Hon Senior Lecturer in Primož Strojan This year, we have expanded the Editorial Board with the addition of Surgical Oncology Professor Zhiqiang Gao and Professor Shusheng Gong from China. To Doncaster Royal Infi rmary Fungal infections in rhinology 109 Doncaster, UK keep with the growing body of scientific knowledge and improve on the Yujay Ramakrishnan and Shahzada Ahmed E-mail: editorial scrutiny, new co-editors for each of the four sections have joined [email protected] the board. Andrea Thirwall and Hasnaa Ismail-Koch have taken the role of Odontogenic causes of maxillary sinusitis and their management 116 editing the Paediatric Section from Michael Kuo, to whom we are James Barraclough, Andrew Birnie and Zarina Shaikh extremely grateful for producing outstanding articles for volume 8. Michael had to step down because of his extensive commitments. Ricard Simo Body dysmorphic disorder and aesthetic treatment 122 will be joined by Ian Nixon as a Head & Neck Section co-editor, Charlie Max Malik and Ayman Zaghloul Huins joins Richard Irving in Otology and Alwyn D’Souza joins Shahzada Ahmed in Rhinology and Facial Plastics. The Rhinology Section has Haemorrhagic hereditary telangiectasia in ENT 126 always encompassed Facial Plastics articles and we have incorporated Suzanne Jervis, Tom Beech and Derek Skinner this in the title. Chairman Editorial Board: Endoscopic vidian neurectomy for intractable vasomotor rhinitis 131 Mr Hesham Saleh (UK) The quality of articles remains of a very high standard and we hope to Bhaskar Ram and Vamsidhar Vallamkondu Sub-Editors: keep this resource free for all ENT surgeons in UK and abroad. To this end, the journal has also been distributed in symbolic numbers to some Paediatrics: Abstracts: ENT Masterclass Trainees’ Gold Medal 2016 135 Ms A Burgess & Ms H Ismail overseas countries like Germany, India, Saudi Arabia and China. Otology: ® Disclaimer: The individual authors have responsibility for the integrity of the content of the manuscripts. Mr R Irving & Mr C Huins On the other front, over the last 12 months the ENT Masterclass platform Rhinology: has continued to expand its academic profile. Within UK, the National Mr S Ahmed & Mr A D’Souza Audiology & Balance Masterclass was well received, as was the Head & Neck: Masterclass for General Practitioners. Mr R Simo & Mr I Nixon To cater for the high international demands, ENT Masterclass® China was Editorial Board: held in Beijing and Hong Kong with over 600 delegates. For Europe, Berlin hosted a very well attended 2-day Masterclass with delegates from all Prof S S Musheer Hussain (UK) ® Prof Deepak Mehta (USA) corners of the continent. In April 2017, the ENT Masterclass Academic Prof Anthony Narula (UK) Travelling Club is planning a substantive event in Cape Town with Prof Shakeel R Saeed (UK) Professor Johan Fagan and his team. Prof Mumtaz Khan (USA) Mr James England (UK) We continue to support online resources and are very pleased that the 4th Prof Alok Thakar (India) Edition of the Cybertextbook with over 400 surgical videos still remains a Mr Faruque Riffat (Aust) very popular part of the website: www.entmasterclass.com. Prof Carsten Palme (Aust) Prof Shu Sheng Gong (China) Prof Zhiqiang Gao (China) The free ENT Masterclass educational resources have expanded beyond Prof Oliver Kaschke (Germany) our expectation when it started as a revision course in Doncaster in 2005. Prof Nirmal Kumar (ENT-UK) It is all down to the generous and selfless contributions from UK and Mr Amit Prasai (UK) international faculty, and the continuing support and interest of the ENT community. Once again we hope that we continue to provide a free Emeritus Editor: educational value that is accessible to all. Prof Patrick Bradley (UK) ENT Masterclass®, Mr Hesham Saleh, FRCS (ORL, H&N) 106 Nottingham Road, Consultant Rhinologist/Facial Plastic Surgeon Ravenshead,Nottingham Charing Cross and Royal Brompton Hospitals, London. NG15 9HL England Chairman, Editorial Board, Journal of ENT Masterclass®. www.entmasterclass.com December 2016. 2 3 JOURNAL OF ENT MASTERCLASS® YEAR BOOK 2016 VOLUME 9 NUMBER 1 reliable in young children. Lumbar puncture (LP) is rather than the middle cranial fossa. An extradural abscess Intracranial complications of suppurative usually required to provide a definitive diagnosis via CSF closely associated with the sigmoid sinus is termed a peri- chemistry and culture, but raised intracranial pressure sinus abscess. Symptoms are a spiking fever and headache ear disease (ICP) may make this procedure perilous, and imaging is despite appropriate antibiotic therapy, deep pain in the usually considered mandatory before LP is undertaken. mastoid region and otorrhoea5. Extradural abscess is James E.F. Howard and Matthew S. Rollin Analysis of obtained CSF will show cloudy fluid, >1000 frequently associated with other complications of acute ENT Department, St Mary’s Hospital, Imperial College NHS Trust, London. cells per ml, elevated protein, reduced glucose, and infection, such as a brain abscess or dural sinus thrombosis Correspondence: organisms. Myringotomy may provide an alternative and (Fig 1). Localised meningitis is expected, and the involved James E.F. Howard less hazardous route to identification of the causative dura can thicken in response to the intense inflammatory ENT Department, St Mary’s Hospital, Imperial College NHS Trust, London. organism. If the suppurating disease is acute and limited to stimulus (this is termed pachymeningitis). Treatment is Email: [email protected] the middle ear, the mainstay of treatment is intravenous surgical drainage via mastoidectomy combined with antibiotic therapy and further surgery is unlikely to be antimicrobial therapy. Wide mastoid exposure is necessary. If the suppurating disease extends to the recommended, maximising access before addressing the mastoid or is chronic in nature, mastoid exploration may area adjacent to the abscess6. Abstract Imaging is recommended as a first-line diagnostic be required when the patient’s condition allows. If such Intracranial complications of suppurating ear disease are modality in all cases. CT should be contrast-enhanced. CT intervention is contemplated, CT and MR are recommended Empirical antimicrobial regimens are targeted against typically caused by spread of infection to surrounding has the advantage over MR that images can be acquired in order to investigate for further intracranial complications. traditional AOM organisms. A typical regimen is: areas. This can be direct, local or to distant areas via quickly, raising the possibility of a feed-and-sleep scan in It has been reported that meningitis is more frequently Metronidazole with Ceftriaxone or Cefotaxime. Ceftazidime haematogenous spread. The pattern of disease has a young child, and light sedation in an older child. lethal when secondary to chronic otitis media, as opposed may be substituted where there is a suspicion of involvement changed in developed countries in recent years with Contrast-enhanced MRI has a higher sensitivity for fluid to the acute form. Patients with meningitis usually require with pseudomonas (for example in the context of chronic these now being more frequently seen as a complication collections, parenchymal oedema, and vascular high-dependency care, a prolonged course of intravenous ear disease). Vancomycin can be used for coverage of of AOM in young children with only rare cases presenting complications.
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