The Journal of laryngology and otology
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Multicenter Study
Accuracy of clinical assessment of paediatric obstructive sleep apnoea in two English centres.
To ascertain the sensitivity and specificity of clinical diagnosis of obstructive sleep apnoea in children, and to determine if a published clinical algorithm identifies those at high risk of post-adenotonsillectomy complications. ⋯ This study of two English centres confirms that the clinical diagnostic process for obstructive sleep apnoea is reasonably insensitive and has low specificity. The studied algorithm discriminated poorly between children with and without severe obstructive sleep apnoea. Realistic diagnostic screening guidelines for paediatric sleep apnoea are overdue in the UK, where access to polysomnography is limited.
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Review Meta Analysis
Local anaesthesia for manipulation of nasal fractures: systematic review.
To determine the most effective local anaesthetic method for manipulation of nasal fractures, and to compare the efficacy of local anaesthesia with that of general anaesthesia. ⋯ Local anaesthesia appears to be a safe and effective alternative to general anaesthesia for pain relief during nasal fracture manipulation, with no evidence of inferior outcomes. The least uncomfortable local anaesthetic method included topical tetracaine gel.
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To evaluate the quality of out-of-hours ENT on-call cover by junior doctors, in view of the European Working Time Directive and the recent changes in the National Health Service workforce due to the 'Modernising Medical Careers' initiative, in England. ⋯ Night-time ENT care is often provided by junior doctors with little experience of the speciality, who are often also responsible for covering multiple specialities. Many reported not feeling comfortable managing common ENT emergencies. Structured induction programmes would help to provide basic knowledge and should be mandatory for all doctors covering ENT.
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Throat packs are employed in nasal surgery to prevent contamination of the upper aerodigestive tract. Their use is thought to reduce the risk of aspiration and post-operative nausea and vomiting. However, use of throat packs may also be accompanied by increased throat pain. In order to inform our clinical practice, the evidence base for throat pack insertion was reviewed. ⋯ Further, adequately powered trials are required involving patients undergoing rhinological procedures with a higher risk of blood contamination (e.g. functional endoscopic sinus surgery), in order to provide definitive evidence on the morbidity of throat packs in rhinological procedures.
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Review Case Reports
Case of coexisting, ipsilateral nonrecurrent and recurrent inferior laryngeal nerves.
We report an extremely rare case of coexisting, ipsilateral nonrecurrent inferior laryngeal nerve and recurrent inferior laryngeal nerve. ⋯ The surgeon must be aware of the possibility of coexisting, ipsilateral nonrecurrent inferior laryngeal nerve and recurrent inferior laryngeal nerve, and thus must trace the nerve in its entirety. Occasionally, what appears to be a nonrecurrent inferior laryngeal nerve will actually be a communicating branch between the recurrent inferior laryngeal nerve and the oesophageal or sympathetic ganglia. If such a neurological variant is present, the consequences of careless dissection could include not only vocal fold paralysis but also dysphagia (if the pharyngeal and oesophageal branches of nonrecurrent or recurrent inferior laryngeal nerve are injured).