Browsing by Department "Division of Otorhinolaryngology"

Now showing 1 - 20 of 47
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    Adult tonsillectomy - are long waiting lists putting patients at risk?
    (Health and Medical Publishing Group, 2006) Mulwafu, Wakisa; Fagan, Johannes J; Isaacs, Sedick
    There is a paucity of data on morbidity associated with long waiting lists for adult tonsillectomy. The aim of this study was to assess the morbidity associated with long waiting lists for adult tonsillectomy in a developing world setting. Of 350 patients on the waiting list at Groote Schuur Hospital for 18 months or more, only 55 were contactable. This low yield (15.7%) from the telephonic survey highlighted the difficulty of managing long waiting lists efficiently in a developing world setting. As only 1/55 patients on the waiting list had a complication (quinsy), it appears to be safe to delay tonsillectomy in adult patients. Only half of patients ultimately required tonsillectomy because of a natural reduction in the number of episodes of tonsillitis with time. In order to avoid unnecessary tonsillectomy we need to find better prognosticators to identify the subgroup of adult patients likely to have continued recurrent tonsillitis
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    Aluminium acetate solution in the treatment of chronic suppurative otitis media
    (2005) Thorp, Marc A; Prescott, C A J; Harrison, R V
    Includes bibliographical references (p. 99-110).
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    Aminoglycoside-induced hearing loss: South Africans at risk
    (2009) Bardien, Soraya; de Jong, Greetje; Schaaf, H Simon; Harris, Tashneem; Fagan, Johan; Petersen, Lucretia
    South Africa is currently experiencing a TB epidemic with an estimated incidence of 940/100 000 population/year, and the country has been ranked 4th among the 22 high-burden TB countries worldwide by the World Health Organization (WHO). A potentially devastating threat to TB control is the emergence of multidrug-resistant TB (MDR-TB) and, more recently, extensively drug-resistant TB (XDR-TB), mainly as a result of poor drug adherence by TB patients and incorrect management or treatment regimens by health providers; however, direct transmission of drug-resistant strains also plays an important role. The MDR/XDR-TB strains necessitate prolonged chemotherapy for up to 2 years or more, and the use of more toxic second-line drugs including the aminoglycoside (streptomycin, kanamycin and amikacin) and polypeptide (capreomycin) antibiotics. In South Africa, in accordance with WHO guidelines, streptomycin is used for retreatment of TB while kanamycin, amikacin and capreomycin are used to treat MDR/XDR-TB.
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    An approach to the patient with a post-nasal drip and rhinosinusitis
    (2009) Lubbe, D E
    Post-nasal drip (PND) can be a bothersome symptom and one of the main reasons for patients visiting a general practitioner (GP), pulmonologist or ear, nose and throat (ENT) surgeon. It can be either a symptom, sometimes not appreciated by the examining practitioner, or an important clinical sign suggesting rhinosinusitis. This article aims to explain the aetiological factors and initial work-up of the patient with a PND and rhinosinusitis and suggest a treatment paradigm for practitioners.
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    Avoiding allogenic blood transfusions in endoscopic angiofibroma surgery
    (2016) Wasl, Hisham; McGuire, Jessica; Lubbe, Darlene
    BackgroundSurgical approaches for many tumours are often limited by blood loss, exposure and risk to vital anatomical structures. Therefore, the standard of care for certain skull base tumours has become endoscopic transnasal resection. Other surgical disciplines often use cell salvage techniques, but review of the otolaryngology literature revealed very few case reports. This study investigated the value and safety of salvage-type autologous blood transfusion during the endoscopic resection of juvenile nasopharyngeal angiofibromas (JNA).MethodsJNA is a rare vascular nasal tumour and the study extended over a 3-year period to obtain adequate patient numbers. All patients undergoing endoscopic resection during this period were included in the population sample. Ten patients with JNA were identified and underwent embolization prior to the endoscopic resection. In all cases the intraoperative blood salvage apparatus was used. Close post-operative monitoring was performed.ResultsHomologous blood transfusion could be avoided in all cases. Postoperative monitoring revealed transient bacteraemia in two cases where the leukocyte filter was not used, but no evidence of septicaemia.ConclusionsPerioperative cell saver and autologous blood transfusion in endonasal JNA surgery is safe. Homologous blood transfusion can be avoided by using this technique. The use of cell salvage allows for single stage surgery without the need to abandon surgery due to excessive blood loss and its future use is promising.
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    A biomechanical study of the movements of the arytenoid cartilage
    (1981) Sellars, Ione; Keen, E N
    The joint between the arytenoid cartilage and the cricoid cartilage is one of the smallest in the body. Its existence has been known since, if not before, the time of Galen (130-201 A.D.). However, little anatomical study has been carried out on this synovial joint and publications based on research into its exact anatomy and function are few. The results of these studies have been rarely questioned or scientifically re-examined, with the consequence that authoritative anatomical texts have perpetuated unconfirmed ideas of the behaviour of the cricoarytenoid joint. The purpose of this thesis is to present in detail the results of research into the anatomy and the functions of the cricoarytenoid joint and of the muscles that act upon it. This research began in 1977 with the dissection of 45 cadaver larynges. In this initial study the most striking anatomical finding was the identification of the so-called "posterior" cricoarytenoid ligament, of which inadequate and often incorrect detail has been presented in standard anatomy texts. Another surprising finding of this work was the variability of the shape and positions of the two cricoid facets. In 1978 these findings were published in detail (Sellars and Keen). An attempt to understand the accepted muscular control of the cricoarytenoid joint led to further research. This was carried out by the dissection of a further 23 larynges, with special care to examine the exact origin, direction and insertion of each muscle concerned. Six of these larynges, which had been surgically excised, were also stimulated electrically immediately after excision and the resultant arytenoid cartilage movements were recorded and analysed. The findings of this study were published in 1978 (Sellars) and these articles (Sellars and Keen, 1978; Sellars, 1978) are referred to in "Gray's Anatomy" and in Grant's "Method of Anatomy" (Sellars and Keen, 1978). Further examination of the reactions of these intrinsic laryngeal muscles to electrical stimulation has since been done on three additional fresh operative specimens. This additional work on laryngeal muscle action suggests that the explanation of specific intrinsic laryngeal muscle actions made in the earlier publication (Sellars, 1978) had been oversimplified. The main experimental work, on which this thesis is based, attempts to clarify and interpret the highly complex synchronized muscle actions that occur at the cricoarytenoid joint. Relevant facts found in both recent and old publications relating to this subject are presented and discussed. Before the review of literature is presented the embryology and basic anatomy of the larynx are described.
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    Comparing the efficiency of beclomethasone, fluticasone and mometasone nasal sprays in a Samter's population
    (2015) Monteiro, Pedro Vilas Boas; Lubbe, Darlene
    Statement of problem: Topical corticosteroids nasal sprays remain first line of treatment for patients with chronic rhinosinusitis (with or without nasal polyps). The main aim of treatment is to improve nasal symptoms by reducing or eliminating the nasal polyps and preventing polyp recurrence post-operatively. Our aims were to determine if the type of corticosteroid nasal spray used post operatively influences polyp recurrence rate and if there were any subsequent economic implications as we only have beclomethasone available for prescription in our state hospital. Methods: Retrospective case note review of all Samter's patients who underwent fronto-spheno-ethmoidectomy by a single surgeon (2000 – 2014). Results: 58 patients were included in our study, divided into 3 study groups. When compared to patients using beclomethasone; patients using fluticasone had an 80% reduced risk of polyp recurrence and patients using mometasone a 90% reduced risk. This rose to 88% and 96% respectively when adjusted for age. Conclusion: Fluticasone and mometasone are both statistically significantly more effective at reducing polyp recurrence than beclomethasone in our population group. Mometasone appeared more effective than fluticasone, but this difference was not statistically significant.
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    Development and evaluation of a free-field voice test for potential use as a community screening tool for hearing impairment in children
    (1999) Omoding, Sammy S; Prescott, C A J; Ogilvy, Dale
    Early identification of hearing impairment in children is essential to avoid potentially disabling effects of hearing loss or deafness. This necessitates effective screening measures appropriate to the community in question. Current methods used in South Africa, especially for pre-school and school going children have resulted in poor coverage as they are designed for the more developed countries. There is thus a need to devise a screening method that is appropriate to our local conditions. In this study, a free-field live voice test was developed based on three levels: whisper, conversational and loud. This was evaluated against pure tone audiometry for sensitivity, specificity, cost and ease of application in two studies: hospital and school- based. A total of 394 children were tested; 189 in hospital-based study and 205 in school based study. 378 of the total were eligible for analysis. In the hospital-based study, the results of 177 children were analysed. The age range was 3 - 12 years with a mean of 5.8 years. The sensitivity (ability of the test to detect hearing impairment) was 80.0%; and the specificity (ability to identify children with normal hearing) was 95.0%. In the school-based study, done after modification and standardisation of the test set, the sensitivity and specificity were 83.3% and 97.8% respectively. Age range was 3 - 8 years with 79% being 4- 6 years. In both studies, the voice test was simpler to perform, easily understood and acceptable to the children and the testers; and considerably cheaper as the only equipment required was picture/toy set. The main limitation was non-standardisation of the test set. This was rectified in the school-based study. The drawbacks noted were the inability of the voice test to detect unilateral hearing loss/deafness and high frequency hearing loss. The voice test generally correlated well with pure tone audiometry and could be used as alternative for screening for hearing impairment in the community especially for pre-school and school going children. However, it is recommended to repeat the study in actual community settings using Community Health Care Workers as the testers. This would also determine the reliability of the voice test, as this cannot be reliably established at this stage.
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    Do proton pump inhibitors reduce the incidence of pharyngocutaneous fistulae following total laryngectomy?
    (2013) Stephenson, Katherine Anna; Fagan, Johan
    Pharyngocutaneous fistula is a common complication of total laryngectomy. We hypothesised that perioperative proton pump inhibitor (PPI) treatment could reduce the incidence of pharyngocutaneous fistulae. This prospective placebo-controlled double-blind randomised controlled trial compared PPI treatment (14 days enteral omeprazole) with a placebo in patients undergoing primary total laryngectomy. The incidence of pharyngocutaneous fistula was recorded.
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    Does sentinel lymph node biopsy have a role in node-positive head and neck squamous carcinoma?
    (2013) Edkins, O; Hofmeyr, C; Fagan, J
    OBJECTIVES/HYPOTHESIS: The objective of the study was to determine whether sentinel lymph node biopsy (SLNB) can be used to reduce clinical overstaging of cervical nodes in head and neck squamous cell carcinoma (SCC) in a developing world setting. STUDY DESIGN: Sentinel and echelon lymph nodes were identified by means of a combination of lymphoscintigraphy, gamma probe and blue dye identification. They were analysed histologically and their pathological status was compared with the rest of the neck dissection specimen to determine diagnostic accuracy in patients with T1-4 N0-3 SCC of the oral cavity or oropharynx undergoing primary surgical resection and neck dissection. RESULTS: Thirty-three patients were included in the study, 13 in the node-negative (N0) and 20 in the node-positive (N+) group. In the clinically N0 group the sensitivity of SLNB was 100% and the negative predictive value (NPV) 100%. In the clinically N+ group the sensitivity was 71% and the NPV 60% for staging the nodal status of the neck. CONCLUSIONS; The accuracy of SLNB in the clinically N+ neck is too low for SLNB to be a means of avoiding comprehensive neck dissection. LEVEL OF EVIDENCE: 2B.
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    Does thyroid sparing total laryngectomy decrease the risk of hypothyroidism?
    (2022) Viljoen, Gerrit; McGuire, Jessica K; Fagan, Johannes J
    Introduction Thyroid lobectomy is recommended with total laryngectomy for laryngeal cancer in the National Comprehensive Cancer Network (NCCN) guidelines. However, it is associated with a 32-89% risk of hypothyroidism, which represents a problem especially for patients without access to thyroid hormone monitoring and replacement. Sparing the thyroid gland does not compromise oncological control if thyroid lobectomy is reserved for intraoperative evidence of extra laryngeal tumor extension abutting or invading the thyroid gland, or when there is need to resect level 6 lymph nodes with subglottic and pyriform fossa involvement. However, there is limited evidence about to what extent hypothyroidism is avoided if the thyroid gland is completely spared compared to hemithyroidectomy in the setting of a total laryngectomy. Aims The aims of the study were to determine whether preserving the whole thyroid, compared to a single lobe, does indeed significantly lower the incidence of hypothyroidism in the setting of a total laryngectomy with or without adjuvant radiotherapy. Method A retrospective study was done at Groote Schuur Hospital in Cape Town, South Africa. The thyroid function of patients who had undergone thyroid sparing total laryngectomy with or without radiotherapy was determined and compared to those who underwent hemithyroidectomy. Results Eighty-four patients met the inclusion criteria. The overall incidence of hypothyroidism was 45.2%. The incidence of hypothyroidism was significantly reduced in patients who underwent thyroid sparing total laryngectomy compared to hemithyroidectomy (p=0.037). Adjuvant radiotherapy was associated with a higher incidence of hypothyroidism (p=0.001). Conclusion Thyroid preserving laryngectomy should be advocated in carefully selected patients with advanced laryngeal carcinoma as it reduces the incidence of hypothyroidism.
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    Ear, Nose and Throat tutorial
    (2010) Copley, Graeme
    This resource is a practical video tutorial for medical students demonstrating equipment and techniques for examining the ear, nose and throat, as well as head and neck. Designed for use with fifth year medical students, this resource is useful for any medical student looking to improve their practical knowledge of ENT examination techniques.
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    The effect of cloth stoma covers on the tracheal climate of laryngectomised patients
    (2014) Quail, Gavin; Raynham, J J; Fagan, Johan
    Includes summary. Includes bibliographical references.
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    The effect of Cloth Stoma Covers on the tracheal climate of laryngectomised patients
    (2014) Quail , Gavin Sean
    Patients that have undergone a laryngectomy lose the normal heat-moisture-exchange functions of the nose and upper airways. Breathing unconditioned air can cause irritation of the tracheal and bronchial mucosa and lead to chest complaints such as irritating coughing and excessive mucus production and mucus plugs. Disposable HME's that cover the tracheostoma and are stuck to the skin with adhesives are believed to improve the condition of inspired air for laryngectomy patients. HME's work by accumulating heat and moisture during exhalation and reciprocally warming and humidifying in spired air. Due to the cost of HMEs they are not affordable to the general population in South Africa and many other countries. Stoma Covers are simple devices made of a single fabric or combinations of fabrics that are fastened around the neck with the cloth covering the tracheostoma. They are relatively inexpensive to manufacture and can be washed and re-used. No research has been conducted to date regarding the effect of using simple Stoma Covers to improve the tracheal climate in laryngectomy patients.
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    Endoscopic Resection and Post-Operative Brachytherapy in the Treatment of Sinonasal Melanoma
    (2019) Alhadad, Abdulrauf I; Lubbe, Darlene; Lubbe, Darlene
    Background: Sino-Nasal Melanomas (SNM) are rare, aggressive tumours often associated with a poor prognosis due to advanced stage disease at presentation. Mean 5-year survival is 0-46%. Various treatment modalities are used in the management of SNM. Surgery is regarded as the primary treatment modality, but therapy remains controversial. Complete resection is a surgical challenge and it is often impossible to achieve adequate margins due to the fact that tumour often abuts vital anatomical structures. Incomplete resection has been shown to be a predictor of poor survival. Harris et al. (2014) were the first to report on the use of post-operative brachytherapy in an attempt to prevent local recurrence after endoscopic resection of SNM. Methods: A retrospective analysis of all patients undergoing endoscopic resection of SNMs and receiving adjuvant brachytherapy in a single surgeon’s practice between August 2004 and May 2014 was carried out. Outcome measures included local control rate and 5-year overall survival estimated by Kaplan-Meier analysis. The incidence of regional and distal recurrence (metastases) was calculated Results: Five cases of sinonasal melanoma (3 males 2, females) were managed with endoscopic resection and adjuvant brachytherapy. Patients were followed up for a median duration of 61 months (32-154 months) following adjuvant Brachytherapy. Local control was achieved in four out of five patients (80%). Three out of five patients developed distant metastasis. Median time to metastasis was 54 months. One patient received immunotherapy after diagnosis of distant metastasis (BRAF positive). Three out of five patients (60%) died from the complications of distant metastases of sinonasal melanoma. Median survival time following adjuvant Brachytherapy was 61 months (32-154 months). Five-year survival rate was 40% (95% CI 5.2% - 75.3%). Conclusion: This is the only case series describing the use of brachytherapy following endoscopic resection of sinonasal melanoma. Our case series, albeit small, describes a local control rate and 5-year survival comparable with the best reported in the literature. Adjuvant brachytherapy represents a novel approach and potentially a useful addition to the adjuvant therapy armamentarium. The advantages of brachytherapy include a favourable side-effect profile and a shorter duration of treatment, while delivering a dose of radiation similar to that of Conventional Radiotherapy. Further studies are necessary to define the role of brachytherapy in sinonasal melanoma.
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    Evaluation of the Welch Allen Microtympanometer compared to conventional examination methods : the effect of general anaesthesia on microtympanograms and middle ear effusions : the use of tympanometry in pre-school audiological screening programme
    (1995) Black, John Henry; Sellars, S L
    1) Test the accuracy of the Welch Allyn Microtympanometer against standard tympanometry. 2) Correlate preoperative clinical findings with: • Microtympanometry • Standard tympanometry 3) Assess influence of induction by gas anaesthesia on: • Post-induction microtympanometry • Intraoperative myringotomy findings 4) Assess the practicality of using the Welch Allyn Microtympanometer as a screening tool in Pre-School audiological testing.