The Journal of laryngology and otology
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Pulsatile tinnitus usually originates from vascular structures, causing an arterial or venous bruit. We report a new cause of pulsatile tinnitus: a focal defect of the mastoid bone shell in the region of the transverse-sigmoid junction, with a normal transverse-sigmoid sinus. ⋯ A focal defect of the mastoid bone shell overlying the transverse-sigmoid sinus, with no abnormality of the sinus itself, may be a new cause of pulsatile tinnitus. Surgical reconstruction of the mastoid bone shell overlying the transverse-sigmoid sinus can provide lasting symptom relief for patients with pulsatile tinnitus and computed tomographic evidence of the defect.
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Case Reports
Surgical tracheostomy in morbidly obese patients: technical considerations and a two-flap technique for access.
In an era in which percutaneous tracheostomies are frequently performed in 'suitable' necks, more technically complex cases are referred to the otolaryngologist. We describe the surgical technique used and close cooperation required in securing the airway of a morbidly obese patient. ⋯ We describe safe airway surgery in a morbidly obese man, and outline requirements including the use of a specially designed operating table, the need for an elongated proximal limb tracheostomy tube, and the use of a distal two-flap technique for access to a deeply plunging trachea.
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Despite longstanding concern, provision of undergraduate ENT teaching has not improved in response to the aims of the UK General Medical Council's initiative Tomorrow's Doctors. Previous studies have demonstrated poor representation of ENT within the undergraduate curriculum. We aimed to identify current practice in order to establish undergraduate ENT experience across UK medical schools, a timely endeavour in light of the General Medical Council's new 2011-2013 education strategy. ⋯ Little improvement in the provision of undergraduate ENT teaching was demonstrated. An increase in the proportion of students undertaking ENT training is necessary. Time and curriculum constraints on medical schools mean that optimisation of available resources is required.
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We present the first report of methicillin-resistant Staphylococcus aureus and Propionibacterium acnes parotid abscesses complicated by facial nerve palsy. Facial nerve palsy secondary to parotid gland abscess is rare, with only eight previously reported cases. ⋯ Parotid gland abscess can lead to facial paralysis. Both methicillin-resistant Staphylococcus aureus and Propionibacterium acnes may be involved. Ultrasonography or computed tomography is recommended to exclude a parotid abscess in patients presenting with suppurative parotitis.
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To demonstrate that patients who have been intubated for prolonged periods of time will have an increased likelihood of developing bacterial biofilm on their endotracheal tubes. ⋯ Longer duration of intubation is associated with a higher incidence of bacterial biofilm. Further research is needed to link the presence of bacterial biofilms to acquired laryngotracheal damage.