The Journal of laryngology and otology
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Tranexamic acid is a synthetic antifibrinolytic drug. It has been widely available for over 40 years, but only recently has it started to be used routinely in many surgical disciplines. For ENT surgeons, epistaxis and post-tonsillectomy bleeding contribute a significant proportion of the morbidity and emergency workload in a general ENT department. Published evidence indicates a potentially helpful role for tranexamic acid in managing epistaxis. ⋯ To date, the benefits of tranexamic acid as a prophylactic treatment to reduce the rate and severity of post-tonsillectomy bleeding are less certain. Two recently published pilot studies looking at primary haemorrhage in children and secondary haemorrhage in adults following tonsillectomy suggest that further large, randomised trials should explore the efficacy of tranexamic acid in routine ENT surgery. There are potential reductions in patient morbidity and cost savings if tranexamic acid is found to be efficacious in larger trials.
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Review Case Reports
Munchausen syndrome by proxy presenting as hearing loss.
To review the diagnosis of Munchausen syndrome by proxy, a factitious disorder, in which symptoms are induced or feigned, usually in a child, by the caregiver. The involved caregiver seeks to gain attention or sympathy and often has a psychological need to maintain the sick role. We highlight the diagnostic difficulties and factors that may help with diagnosis in an otolaryngology setting. ⋯ Munchausen syndrome by proxy is a diagnosis that otolaryngologists should be aware of, particularly where recurrent or persistent illnesses in children, especially those involving otological symptoms, are refractory to the usual treatments.
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Recurrent aphthous stomatitis is a common disease of the oral mucosa, affecting 20 per cent of the general population.1 However, the aetiology of this disease is unknown. This is the first controlled study to compare zinc levels in recurrent aphthous stomatitis patients with those of a well-matched, healthy, control population. ⋯ These results suggest an association between zinc deficiency and recurrent aphthous stomatitis.
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To systematically summarise the peer-reviewed literature relating to the aetiology, clinical presentation, investigation and treatment of geniculate neuralgia. ⋯ The response to medical treatment for this condition varies between individuals. The long-term outcomes of surgery remain unknown because of limited data.
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This study presents the incidence of denture impaction in the oesophagus, and discusses the difficulties of managing such cases. ⋯ In cases of impacted dentures in the oesophagus, a positive history helps in the diagnosis, but a high degree of clinical suspicion aids early detection. Conventional radiographs are important but may not always be of assistance. Early intervention reduces complications. Dentures that are poorly maintained and old are more likely to be swallowed accidentally. The inclusion of radiopaque filler within dentures would assist localisation following accidental swallowing.