Yung M.,Ipswich Hospital NHS Trust |
Bennett A.,Royal Infirmary
Current Opinion in Otolaryngology and Head and Neck Surgery | Year: 2013
Purpose of Review: To evaluate the choice of techniques, safety and long-term outcome of mastoid obliteration and assess the place of imaging in the postoperative monitoring of residual cholesteatoma. Recent Findings: All recent reports on mastoid obliteration for the management of cholesteatoama were favourable. Long-term follow-up reports did not show problems arising from hidden cholesteatoma, even for the paediatric population. Non-EPI DW MR imaging has shown great promise in detecting residual cholesteatoma in obliterated cavities. Summary: Canal wall down technique with primary mastoid obliteration for cholesteatoma has low recurrent and residual cholesteatoma rates. Most ears remained dry and waterproof on long-term follow-up. © 2013 Lippincott Williams and Wilkins.
Yung M.,Ipswich Hospital NHS Trust |
Smith P.,A+ Network
Otology and Neurotology | Year: 2010
OBJECTIVE:: The study compares the medium-term outcome of ossiculoplasty using titanium and nontitanium prostheses. STUDY DESIGN:: Randomized controlled, prospective clinical trial. SETTING:: District general hospital. PATIENTS:: Patients with chronic otitis media with partial and total ossicular reconstructions were included. Trauma and congenital malformation cases were excluded. INTERVENTION(S):: Partial and total ossicular reconstructions using either titanium (Ti) or hydroxyapatite (HA) prostheses. Cartilage plate was used to cover the Ti head plate but not the HA head plate. MAIN OUTCOME MEASURE(S):: The principal outcome was hearing gain and postoperative air-bone gaps. The secondary outcome was extrusion of the prosthesis. RESULTS:: The mean hearing gain in the HA partial ossicular replacement prosthesis (PORP) and the Ti PORP cohorts were 14.30 and 15.10 dB, respectively. The mean hearing gain in the HA total ossicular replacement prosthesis (TORP) and Ti TORP cohorts were 13.52 and 13.48 dB, respectively. There was no significant difference between HA and Ti for both PORPs and TORPs. There also was no significant difference in the extrusion rate between both prostheses. CONCLUSION:: The lack of statistical difference in the clinical outcome of the 2 prostheses may be due to the limitation of randomized controlled trial with the small sample size and limited statistical power in the comparison of surgical techniques. Copyright © 2010 Otology & Neurotology, Inc.
Watts R.A.,Ipswich Hospital NHS Trust
Best Practice and Research: Clinical Rheumatology | Year: 2014
The investigation of the patient with possible systemic autoimmune rheumatic disease is potentially one of the most challenging areas of rheumatology as the differential diagnosis is potentially very broad. The investigative approach should not only be directed at confirming the diagnosis of an autoimmune rheumatic disease but also at excluding as best as possible the major alternative diagnoses of malignancy and infection. A systematic approach should yield a positive diagnosis in the majority of cases based on excluding infection by appropriate cultures and serology, malignancy using imaging including 18-fluorodeoxyglucose positron emission tomography/computerized tomography (FDG PET/CT). The most important part of the assessment is the history, in particular covering systems that may not previously been assessed such as ears, nose, throat or eyes. The clue to the diagnosis of an autoimmune rheumatic disease often lies in detecting the multisystem nature of the condition and the cumulative effects of multiorgan involvement. Investigation may therefore need to cover different systems. Although stratified approaches have been described, they have not been subjected to a detailed investigation as to their effectiveness. © 2015 Elsevier Ltd. All rights reserved.
Yung M.,Ipswich Hospital NHS Trust
Otology and Neurotology | Year: 2016
Objective: To find out if the use of the vascularized temporo-parietal fascial flap (TPFF) reduces postoperative infection or wound breakdown in subtotal petrosectomy for chronic discharging ears. Patients: A retrospective review on 26 subtotal petrosectomies with blind pit closures on chronic discharging ears performed by a single surgeon between 2000 and 2015 was performed. All patients had a minimum follow-up period of 6 months. Intervention: Eleven mastoid cavities were obliterated with abdominal fat, and 15 cavities were obliterated with TPFF. There was no concomitant cochlear implant or middle ear implant. Main Outcome Measure(s): All postoperative wound infections or delay in wound healing were recorded into a database. The complication rates of the fat obliteration group were compared using Fisher's exact test with those for the TPFF obliteration group. Results: In the fat obliteration group, 4 out of 11 patients had documented postoperative complications. Three had wound breakdown with exposure of the fat that required revision surgery. Another patient had postauricular abscess without the wound actually broken down. On the other hand, all the ears in the TPFF obliteration group (100%) were completely free of wound infection, wound breakdown, or any complication. The difference between the two groups was statistically significant ( p=0.022). Conclusion: Many authors have encountered postoperative infection or wound breakdown in subtotal petrosectomy with fat obliteration in the treatment of chronic otitis media. Using a richly vascularized temporo-Temporal fascial flap to protect the blind pit closure in such patients reduces postoperative infection and wound breakdown. © 2016, Otology & Neurotology, Inc.
de Beer J.F.,Cape Shoulder Institute |
Roberts C.,Ipswich Hospital NHS Trust
Orthopedic Clinics of North America | Year: 2010
Recurrent anterior shoulder instability is commonly associated with glenoid bone defects. When the defect is significant, bony reconstruction is typically necessary. The congruent arc modification of the Latarjet procedure uses the concavity of the undersurface of the coracoid to optimally reconstruct the glenoid. Outcomes are maximized and complications minimized. © 2010.