Journal of Laryngology and Otology 2024-05-14

Preparing juniors for on-call ENT, handicap in vestibular schwannoma, nasal packs in epistaxis and sleep apnoea in young children

Fisher, Edward W,Fishman, Jonathan

Publication date 14-05-2024


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Learning needs of junior doctors in otolaryngology: a qualitative study

Morris, Simon,Owens, David,Cserzo, Dorottya

Publication date 17-01-2024


Objectives There is concern that junior doctors are not prepared for their post-graduate attachments in ENT. The aims of this study were to capture the learning priorities of those in the ENT first on-call role and facilitate further educational opportunities to address these needs.
Method Semi-structured interviews were undertaken to explore the learning needs of junior doctors with seven junior and two senior ENT clinicians.
Results The thematic analysis generated three themes: the role of the ENT Junior; the perceived, expressed and prescribed learning needs; and attitudes towards future learning. These themes explored the misalignment between undergraduate training and post-graduate expectations, the lack of competence in ENT practical skills and the need for focused ENT training prior to commencing on-call shifts.
Conclusion All interviewees identified the need for greater experience in practical interventional skills prior to their ENT attachments and expressed interest towards a standardised, bootcamp-style induction with simulated emergency experience.

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Does coronavirus disease 2019 affect peripheral and central auditory systems? Matched group cross-sectional study and six-month follow up

Deniz-Sakarya, Merve,Yorulmaz, İrfan

Publication date 08-03-2024


Objective This study aimed to compare the peripheral-to-central auditory systems of people with coronavirus disease 2019 to a well-matched control group and examine the long-term effects of coronavirus disease 2019 on the auditory system.
Method Participants who were outpatients of coronavirus disease 2019 (n = 30) were compared with a well-matched control group (n = 30). Behavioural and electrophysiological tests were performed, and tests were repeated at six months in the coronavirus disease 2019 group.
Results Statistically significant differences were observed in the right ear at 10 k Hz (p = 0.007) and 12.5 k Hz (p = 0.028), and in the left ear at 10 k Hz (p = 0.040) and 12.5 k Hz (p = 0.040) between groups. The groups had no difference regarding the other audiological test results (p > 0.05).
Conclusion Extended high-frequency thresholds were affected in the coronavirus disease 2019 patients. No other findings indicated that the peripheral-to-central auditory system was affected. The effect on extended high-frequency thresholds appeared permanent, but no clinically significant new, late-onset auditory system effects were observed.

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Changes in audiovestibular handicap following treatment of vestibular schwannomas

Campbell, Tim,Goh, Shao Jie,Wadeson, Andrea M,Freeman, Simon R,Rutherford, Scott A,King, Andrew T,Hammerbeck-Ward, Charlotte L,Pathmanaban, Omar,Entwistle, Helen,Bird, Judith,Axon, Patrick R,Moffat, David A,Lloyd, Simon K

Publication date 29-11-2023


Objective This study aimed to assess degree of audiovestibular handicap in patients with vestibular schwannoma.
Methods Audiovestibular handicap was assessed using the Hearing Handicap Inventory, Tinnitus Handicap Inventory and Dizziness Handicap Inventory. Patients completed questionnaires at presentation and at least one year following treatment with microsurgery, stereotactic radiosurgery or observation. Changes in audiovestibular handicap and factors affecting audiovestibular handicap were assessed.
Results All handicap scores increased at follow up, but not significantly. The Tinnitus Handicap Inventory and Dizziness Handicap Inventory scores predicted tinnitus and dizziness respectively. The Hearing Handicap Inventory was not predictive of hearing loss. Age predicted Tinnitus Handicap Inventory score and microsurgery was associated with a deterioration in Dizziness Handicap Inventory score.
Conclusion Audiovestibular handicap is common in patients with vestibular schwannoma, with 75 per cent having some degree of handicap in at least one inventory. The overall burden of handicap was, however, low. The increased audiovestibular handicap over time was not statistically significant, irrespective of treatment modality.

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Improving otitis externa management in secondary care through a standardised treatment algorithm

Hasan, Waseem,Kennett, Jessica,Bentounsi, Zineb,Amir-Ghasemi, Aria,Jones, Huw,Biggs, Timothy

Publication date 07-12-2023


Objective Otitis externa is a common condition managed by junior doctor-led ENT clinics in secondary/tertiary care, but no national guidelines exist for presentations in these settings. The aim of this study was to implement a treatment algorithm to support junior doctors and improve otitis externa management.
Methods Baseline data were retrospectively collected for 16 weeks. A standardised otitis externa treatment algorithm was then implemented, and 16 weeks of data prospectively gathered. A second improvement cycle was completed thereafter focusing on topical antibiotics and water precaution advice.
Results Overall, 202 cases of otitis externa managed between November 2021 to October 2022 were reviewed. Following the interventions, topical antibiotic prescribing improved (p = 0.01) as well as the provision of water precaution advice (p < 0.01). Junior doctors trended towards reviewing patients more frequently but required less senior support.
Conclusion Our treatment algorithm empowers junior doctors to become more independent in their management of otitis externa and improves overall otitis externa treatment.

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Provision of bone conduction hearing implants in England in adults and children: a review of Hospital Episode Statistics data 2012–2021

Conybeare, Alison,Bennett, Lauren,Osborne, Max S

Publication date 08-03-2024


Objective Bone conduction hearing implants are a well-established method of hearing rehabilitation in children and adults. This study aimed to review any changes in provision in England.
Methods The total number of bone conduction hearing implantations performed was analysed from 2012 to 2021 utilising Hospital Episode Statistics data for England.
Results The total number of procedures has increased by 58 per cent. One-stage bone conduction hearing implantations in adults accounts for the largest proportion of this increase (93 per cent of the total). The number performed in children has remained stable and accounts for 73 per cent (n = 433) of all two-stage procedures.
Conclusion The data show that bone conduction hearing implant surgery is becoming increasingly popular, particularly in adults. This has correlated with the increase in availability, national recommendations and choice of devices.

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Prevalence and management outcomes of tonic tensor tympani syndrome in an ENT audiology tinnitus clinic in Singapore

Tan, Shu Hwei Linette,Lee, Gary Jek Chong

Publication date 21-11-2023


Objective Tonic tensor tympani syndrome is found in a subset of tinnitus patients who experience intra-aural and peri-aural symptoms, in addition to their tinnitus, in the absence of clinically detectable pathology. As the syndrome has not been widely reported, this study aims to determine its prevalence and evaluate the effectiveness of current management.
Methods The tinnitus management clinic records of patients over the past six years were assessed to identify tonic tensor tympani syndrome patients and track their progress based on patient-reported Tinnitus Handicap Index scores. Patients with reversible ear pathology and temporomandibular joint disorder were excluded.
Results It was found that 13 per cent of the tinnitus management patients fulfilled the criteria for tonic tensor tympani syndrome and 94 per cent of those who returned for follow up showed an improvement in their Tinnitus Handicap Index grades.
Conclusion This study suggests that tonic tensor tympani syndrome is a significant problem among tinnitus patients and current tinnitus management strategies contribute effectively to helping such patients habituate to their symptoms.

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Linear transmission between malleus and stapes in cases with incus necrosis

Nassif, Mena Maher,Hamdy, Tarek A.,Saad, Mohmed

Publication date 02-02-2024


Objective The outcome of cartilage interposition ossiculoplasty was assessed in cases of incus necrosis after posterior malleus repositioning in the plane of the stapes, in terms of hearing gain after ossicular reconstruction.
MethodsA retrospective observational study was conducted of 30 patients admitted to an Ain Shams University hospital from March 2021 to September 2021. All patients with ossicular disruption due to chronic suppurative otitis media and hearing loss of more than 40 dB were included in the study. Pure tone audiometry was conducted for each patient after three months, six months and one year post operation.
Results The audiogram showed a post-operative air–bone gap of 20 dB or less in 83.33 per cent of patients (n = 25) at three months post-operatively and in 80 per cent of patients after six months; after one year, the results remained the same.
Conclusion The use of cartilage interposition after malleus posterior mobilisation represents an excellent partial ossicular replacement technique.

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The effect of injection of 1:100 000 adrenaline solution in the pterygopalatine fossa on intra-operative bleeding during endoscopic sinonasal surgical procedures in chronic sinusitis: a blinded clinical trial

Nasirmohtaram, Sevil,Jalali, Mir Mohammad,Faghih Habibi, Ali,Akbarpour, Maliheh

Publication date 17-01-2024


Objective Rhinosinusitis is one of the most common reasons for a visit to otolaryngology clinics. Some patients are candidates for sinus surgery. Infiltration of 1:100 000 adrenaline in the pterygopalatine fossa was studied, with the aim of evaluating the effect on bleeding in the surgical field.
Methods This double-blind clinical trial was conducted in 2021–2022 on 40 candidates for endoscopic sinus surgery. For each patient, one side of the pterygopalatine fossa was randomly selected to be infiltrated with a vasoconstrictor. Surgical field bleeding on each side was evaluated.
Results Blood loss was 35.8 ± 20.9 ml in the study group and 38.4 ± 23.7 ml for the control group, with no statistically significant difference between groups (p = 0.49). In addition, there was no difference between the two groups in terms of the surgical field based on Boezaart scores.
Conclusion Although there are some recommendations on the usage of vasoconstrictors via the pterygopalatine foramen, debate remains.

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Comparison of side effects and patient perceptions towards Rapid Rhino and Merocel packs in epistaxis

Mettias, Bassem,Karia, Chiraag Thakrar,Irvine, Esmee,Conboy, Peter

Publication date 17-01-2024


Objective Non-dissolvable nasal packs (Rapid Rhino and Merocel) are widely used in secondary healthcare centres for the control of epistaxis, with some side effects.
MethodsA prospective, observational cohort study was conducted of adults who required Rapid Rhino or Merocel packing for acute epistaxis management in a large healthcare centre between March 2020 and 2021. A validated modified version of the 22-item Sino-Nasal Outcome Test was used.
ResultsA total of 80 adults requiring non-dissolvable packs were recruited. Seventy per cent of patients had Rapid Rhino packs inserted. Embarrassment was greater in patients who used Rapid Rhino than Merocel. Merocel packs had a significantly higher mean pain score on removal compared to Rapid Rhino. There was no correlation between rebleed rate and type of nasal pack used.
Conclusion Non-dissolvable Rapid Rhino and Merocel nasal packs have similar efficacy in controlling epistaxis. Rapid Rhino packs are more embarrassing for patients in comparison to Merocel packs, but are less painful to remove.

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Threshold and suprathreshold component analysis in olfactory dysfunction: a retrospective study

Brabahar, Berenice Stella,Kurien, Regi,Panicker, Raga,Rebekah, Grace,Varghese, Lalee

Publication date 07-12-2023


Objective To analyse variations in the n-butanol threshold and odour identification scores of the Connecticut Chemosensory Clinical Research Centre test in various grades of olfactory dysfunction and in different nasal conditions leading to olfactory loss.
Method Retrospective observational study.
Results All grades of olfactory dysfunction were predominantly noted among males. In chronic rhinosinusitis, anosmia or severe hyposmia was seen in 87.5 per cent of patients without polyps in comparison with 68 per cent of patients with polyps. In addition, 90 per cent of patients with atrophic rhinitis and post-traumatic loss had anosmia, but only 30.7 per cent of patients with allergic rhinitis had anosmia. Pepper was the most affected smell for all the nasal diseases except atrophic rhinitis, in which asafoetida and baby powder smells were affected more.
Conclusion In most inflammatory sinonasal conditions, odour identification is relatively preserved even when the threshold is maximally affected. In patients with comparable olfactory dysfunction based on the Connecticut Chemosensory Clinical Research Centre test score, a relatively preserved suprathreshold odour identification score may predict better prognosis.

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Internal mammary artery perforator flap in the management of tracheoesophageal fistulae

Kaur, Amrita,Biswas, Gautam

Publication date 08-01-2024


BackgroundA pathological communication between the trachea and oesophagus – a tracheoesophageal fistula – may be congenital or acquired, benign or malignant, necessitating a multidisciplinary approach. Conservative attempts at closure of this abnormal connection are ineffective; the interposition of healthy vascular tissue offers the least chance of recurrence.
Methods Outcomes of an islanded fasciocutaneous internal mammary artery perforator flap applied for tracheoesophageal fistula management were assessed in four radiated patients with laryngeal carcinoma using retrospective records.
Results Four male patients, with an average age of 60.75 years, underwent tracheoesophageal fistula closure between September 2017 and February 2021. A left-sided second internal mammary artery perforator flap was used in all cases, with an average dimension of 10.5 × 4.5 cm. There were no complications of tracheoesophageal leak, flap issues or donor site morbidity on follow up.
Conclusion Recent advances in angiosomal territory mapping and microvascular dissection techniques, combined with an understanding of tracheoesophageal fistula pathology, have changed management perspectives in these difficult-to-treat patients.

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Patient-perceived dysphagia and voice change post thyroid surgery: a telephone questionnaire

Mowat, Andrew,Sandhar, Pardip,Chan, Jacqueline,De, Mriganka

Publication date 07-12-2023


Objective This study analyses the incidence of subjectively experienced dysphagia and voice change in post-thyroidectomy and parathyroidectomy patients without recurrent laryngeal nerve palsy.
MethodsA total of 400 patients were invited to participate in a telephone questionnaire based on the Dysphagia Handicap Index and Voice Handicap Index. At 6–24 months following surgery, participants were divided into: post-thyroid surgery (total, hemi-, parathyroidectomy) groups and controls (other ENT procedures). A total of 254 responses were received (127 following thyroid surgery, 127 controls).
Results Twenty-two per cent of post-thyroidectomy patients had a Voice Handicap Index score of more than 3, compared to 15 per cent of parathyroid patients and 4 per cent of controls. The mean Dysphagia Handicap Index score for patients post thyroidectomy and hemi-thyroidectomy was 2.0. Parathyroidectomy patients had a mean Dysphagia Handicap Index score of 1.3, higher than controls at 1.0.
Conclusion Dysphagia and voice alteration are common following thyroid surgery, even in the absence of recurrent laryngeal nerve injury. Both deficits occur more frequently following thyroid surgery than parathyroid surgery.

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Distant metastasis at the time of presentation of head and neck squamous cell carcinoma: a retrospective chart review from a tertiary cancer care centre

Majitha, CS,Nayak, Dipak Ranjan,Shetty, Shama,Devaraja, K,Basheer, Juhi Irfana

Publication date 22-12-2023


Objective To evaluate the rates and patterns of distant metastasis in head and neck SCC at the time of presentation and to study the association between distant metastasis with pre-treatment, clinical, and pathological predictors of outcomes.
Method This is a retrospective study conducted in a tertiary care hospital. All patients with primary head and neck squamous cell carcinoma that had been evaluated at our institute between October 2018 and December 2020 were included in the study. Various clinical data were analysed and pattern of metastasis was studied.
Result Ten per cent (50 cases) of 501 studied patients had distant metastasis. The most common site of distant metastasis was lung. The rate of distant metastasis was high in patients with poorly differentiated cancers. By Kaplan–Meier analysis, the median survival duration after diagnosis of metastasis was four months.
Conclusion The rate of distant metastasis was 10 per cent in the study. Patients with poorly differentiated tumours, locally advanced primary lesions, higher nodal stage, particularly with extra nodal extension, and hypopharyngeal primary, tend to exhibit increased risk for distant metastasis at the time of presentation.

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A novel remote assessment pathway to streamline the management of two-week-wait suspected head and neck cancer referrals: a prospective analysis of 660 patients

Metcalfe, Christopher,Oh, Soo,Glazzard, Nina,Ross, Elizabeth,George, Ajith

Publication date 19-01-2024


Objective This study analyses outcomes for 660 patients managed via a novel telescopic pathway for suspected head and neck cancer referrals.
Method Data were collected prospectively between January 2021 and December 2022, capturing all two-week-wait referrals triaged as low risk and managed via a nurse-led clinic for nasendoscopic examination and consultant-led remote assessment.
Results In total, 660 patients were included. There were six head and neck cancers diagnosed, giving a conversion rate of 0.9 per cent. Mean (standard deviation) time to informing the patient whether they did or did not have cancer (28-day faster diagnosis standard) was 28.6 days (20.2), with no significant difference observed in patients imaged prior to review (p = 0.63). No missed cancers were detected in the follow-up period.
Conclusion Low-risk head and neck cancer referrals can be safely managed in a nurse-led clinic for recorded examination with asynchronous consultant-led management. Further work is required to ensure adherence to the new faster diagnosis standard.

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Oncological and functional outcomes in T3 and T4 laryngeal cancer patients: choice for larynx preservation or total laryngectomy based on expected laryngeal function

Nobacht, Arman,Meijer, Tineke W H,Oosting, Sjoukje F,van der Vegt, Bert,Wedman, Jan,Halmos, György B,Plaat, Boudewijn E C

Publication date 18-01-2024


Objective To determine oncological and functional outcomes in patients with T3 and T4 laryngeal carcinoma, in which choice of treatment was based on expected laryngeal function and not T classification.
Methods Oncological outcomes (disease-specific survival and overall survival) as well as functional outcomes (larynx preservation and functional larynx preservation) were analysed.
Results In 130 T3 and 59 T4 patients, there was no difference in disease-specific survival or overall survival rates after radiotherapy (RT) (107 patients), chemoradiotherapy (36 patients) and total laryngectomy (46 patients). The five-year disease-specific survival rates were 83 per cent after RT, 78 per cent after chemoradiotherapy and 69 per cent after total laryngectomy, whereas overall survival rates were 62, 54 and 60 per cent, respectively. Five-year larynx preservation and functional larynx preservation rates were comparable for RT (79 and 66 per cent, respectively) and chemoradiotherapy (86 and 62 per cent, respectively).
Conclusion There is no difference in oncological outcome after (chemo)radiotherapy or total laryngectomy in T3 and T4 laryngeal carcinoma patients whose choice of treatment was based on expected laryngeal function.

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The role of rigid laryngo-tracheo-bronchoscopy in children with obstructive sleep apnoea: a case series of 65 children

Dritsoula, Aikaterini,Clarke, Raymond,Hatziagorou, Elpis,Triaridis, Stefanos,Talimtzi, Persefoni,Elphick, Heather

Publication date 29-11-2023


Objective To assess the role of laryngo-tracheo-bronchoscopy in children with obstructive sleep apnoea by identifying airway abnormalities at surgery, that occur separately or in addition to adenotonsillar hypertrophy, and examining the correlation with respiratory parameters.
MethodsA retrospective study was conducted of children with obstructive sleep apnoea who underwent laryngo-tracheo-bronchoscopy intra-operatively, performed by a single ENT surgeon from February 2016 to July 2019. Pre- and post-operative minimum oxygen saturation, apnoea-hypopnoea index, and oxygen desaturation index were recorded.
Results Sixty-five children were identified; 34 were aged less than three years and 31 were aged three years or more. 77 per cent and 13 per cent respectively had an airway abnormality; the t-test showed a significantly higher mean oxygen desaturation index and lower mean minimum oxygen saturation pre-operatively compared to children without an airway abnormality.
Conclusion An update of the surgical pathway for children aged less than three years with obstructive sleep apnoea is required to include laryngo-tracheo-bronchoscopy intra-operatively. A t-test analysis of the pre-operative respiratory parameters suggests that airway abnormalities contribute to obstructive sleep apnoea severity.

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Computed tomography-based radiomic markers are independent prognosticators of survival in advanced laryngeal cancer: a pilot study

Rajgor, Amarkumar Dhirajlal,Kui, Christopher,McQueen, Andrew,Cowley, Josh,Gillespie, Colin,Mill, Aileen,Rushton, Stephen,Obara, Boguslaw,Bigirumurame, Theophile,Kallas, Khaled,"OHara, James",Aboagye, Eric,Hamilton, David Winston

Publication date 14-12-2023


Objective Advanced laryngeal cancers are clinically complex; there is a paucity of modern decision-making models to guide tumour-specific management. This pilot study aims to identify computed tomography-based radiomic features that may predict survival and enhance prognostication.
Methods Pre-biopsy, contrast-enhanced computed tomography scans were assembled from a retrospective cohort (n = 72) with advanced laryngeal cancers (T3 and T4). The LIFEx software was used for radiomic feature extraction.
Two features: shape compacity (irregularity of tumour volume) and grey-level zone length matrix – grey-level non-uniformity (tumour heterogeneity) were selected via least absolute shrinkage and selection operator-based Cox regression and explored for prognostic potential.
ResultsA greater shape compacity (hazard ratio 2.89) and grey-level zone length matrix – grey-level non-uniformity (hazard ratio 1.64) were significantly associated with worse 5-year disease-specific survival (p < 0.05). Cox regression models yielded a superior C-index when incorporating radiomic features (0.759) versus clinicopathological variables alone (0.655).
Conclusions Two radiomic features were identified as independent prognostic biomarkers. A multi-centre prospective study is necessary for further exploration. Integrated radiomic models may refine the treatment of advanced laryngeal cancers.

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A force sensor improves trainee technique for rigid endoscopy

Bola, Sumrit,Shrivastava, Manu Kunaal,Brown, Josh,Cherko, Matthew,Emmanouil, Beatrice

Publication date 17-01-2024


Objective Developing skills in rigid endoscopy poses challenges to the surgical trainee. This study investigates whether a modified manikin can improve the technical skill of junior operators by providing direct quantitative feedback.
MethodsA force-sensing pad was incorporated into the oral cavity of a life support manikin. Junior trainees and senior otolaryngologists were invited to perform rigid endoscopy and received real-time feedback from the force sensor during the procedure.
Results There was a significant inverse correlation between operator seniority and the weight applied to the oral cavity (p < 0.0001). All junior trainee operators applied less weight after five attempts (346 ± 90.95 g) compared to their first attempt (464 ± 85.79 g). This gave a statistically significant decrease of 118 g (standard deviation = 107.27 g, p = 0.007) when quantitative feedback was provided to learning operators.
Conclusion This low-cost, simple model allows trainees to rehearse a high-risk procedure in a safe environment and adjust their operative technique.

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How I do it: novel use of a modified nasopharyngeal airway in laryngotracheal stenosis as a temporary stent

Ghauth, Sakina,Tan, Sien Hui

Publication date 06-11-2023


Background This paper reports the innovative use of a modified nasopharyngeal airway device as a temporary stent in patients with laryngotracheal stenosis. It also discusses the technique of endoscopic stent placement, and our experience in terms of the indications and suitability.
Method The nasopharyngeal airway device was modified to use as an airway stent by trimming it to the desired length. Next, the stent was inserted endoscopically and anchored using a novel approach.
Results The surgery was performed successfully without complications. The patients had full use of their voice while the stent was in situ. No significant granulation tissue was observed.
Conclusion This paper demonstrates the feasibility of using a nasopharyngeal airway device as a temporary stent to prevent restenosis in cases where the patients have a strong demand for phonation. The modified nasopharyngeal airway device is potentially very promising, but cases must be selected carefully to avoid compromising efficacy and safety.

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Cocaine-associated Eustachian tube stenosis causing chronic ‘glue ear’: a rare cocaine-induced destructive lesion

Dar, Talib,Abou-Abdallah, Michel,Michaels, Joshua,Talwar, Rishi

Publication date 08-02-2024


Background Cocaine is one of the most used recreational drugs. Whilst medical uses exist, chronic recreational nasal use of cocaine is associated with progressive destruction of the osseocartilaginous structures of the nose, sinuses and palate – termed cocaine-induced midline destructive lesions.
Case reportA 43-year-old male with a history of chronic cocaine use, presented with conductive hearing loss and unilateral middle-ear effusion. Examination under anaesthesia revealed a completely stenosed left Eustachian tube orifice with intra-nasal adhesions. The adhesions were divided and the hearing loss was treated conservatively with hearing aids. Whilst intra-nasal cocaine-induced midline destructive lesions are a well-described condition, this is the first known report of Eustachian tube stenosis associated with cocaine use.
Conclusion This unique report highlights the importance of thorough history-taking, rhinological and otological examination, and audiometric testing when assessing patients with a history of chronic cocaine use. This paper demonstrates the complexity of managing hearing loss in such cases, with multiple conservative and surgical options available.

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Difficult oesophageal foreign body removal: a novel surgical approach to a complex situation

Dranova, Sabina,Siddiqui, Zohaib,Tobbal, Muhammad,Pitkin, Lisa

Publication date 15-01-2024


Background Ingested foreign bodies pose a unique challenge in medical practice, especially when lodged in the oesophagus. While endoscopic retrieval is the standard treatment, certain cases require more innovative approaches.
Methods This paper reports the case of a patient who intentionally ingested a butter knife that lodged in the thoracic oesophagus. After multiple endoscopic attempts, a lateral neck oesophagotomy, aided using a Hopkins rod camera and an improvised trochar as a protective port, was performed.
Results The foreign body was successfully extracted without causing oesophageal perforation. The patient was made nil by mouth, with nasogastric feeding only until a swallow assessment after one week. The patient was discharged and recovered well.
Conclusion This case illustrates a successful, innovative approach to removing a foreign body in a high-risk patient, highlighting the significance of adaptability in surgical practice. It emphasises the need for individualised approaches based on the patients history, the nature and location of the foreign body, and associated risks.

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Sinonasal and Skull Base Malignancies N F Saba, D T Lin (eds) Springer, 2022 ISBN 978 3 03097 617 0 (hardback) ISBN 978 3 03097 620 0 (softback) ISBN 978 3 03097 618 7 (ebook) pp 189 Price £119.99 (hardback) £89.99 (softback) £71.50 (ebook)

Gohil, Rohit

Publication date 30-11-2023


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Invasive Skull Base Mucormycosis New Perspectives N Janakiram, S P Rao (eds) Thieme, 2024 ISBN 978 9 39539 031 6 pp 307 Price £77.00

Flood, L M

Publication date 30-01-2024


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JLO volume 138 issue 6 Cover and Front matter

Publication date 14-05-2024


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JLO volume 138 issue 6 Cover and Back matter

Publication date 14-05-2024


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