Indications for Adenotonsillectomy in Children

The indications for Tonsillectomy have changed over the years with more understanding about the effects of Obstructive Sleep Apnoea (OSA) in children.
The paper published below is from the Paediatrics and Child health Division of the Royal College of Physicians and The Australian Society of Otolaryngology head and Neck Surgery. It was published in 2008 but still relevant today and to the New Zealand Population.

It emphasises the need to increase the access for adenotonsillectomy for children with moderate to severe OSA.

This is in contrast to what is happening in UK where there has been a 40% planned reduction in Adenotonsillectomy. " The operation has been placed on lists of treatments classed as 'of limited benefit' which are being used by primary care trusts to refuse funding on the NHS."
see http://www.telegraph.co.uk/health/healthnews/9195475/NHS-rationing-leaving-thousands-of-children-suffering-tonsillitis-surgeons.html
So I personally believe we need to be wary of any governmental plan to reduce and control the number of T's and Ads. JG


Final Approved Tonsillectomy Document (3)

Head thrust test- an important test for vertigo.

The head impulse or head thrust test was first described by Halmagyi and Curthoys in 1988.  It has acquired an increasingly important place in the clinical examination of the vertigo patient. It detects severe unilateral loss of semicircular canal (SCC) function clinically; it is more sensitive and specific than the traditional Romberg and similar tests; and it is particularly important in the emergency unit, where it can distinguish between vestibular neuritis and cerebellar infarction, which can both generate similar symptoms suggesting an initial attack of severe acute vertigo.
The result of the head thrust test is definitely normal in a patient with a cerebellar infarction but abnormal in a patient with vestibular neuronitis.

                                                                                                                    Kerber K A , Baloh R W Neurol Clin Pract 2011;1:24-33

see youtube video- Halmagyi Head Thrust Maneuver

Incidental MRI and CT findings in paranasal sinuses and mastoid cells

With increasing numbers of CT and MRI scans being performed, this has lead to an  increase in diagnosis of Sinusitis and Mastoiditis being made and referral to our department.
 Fluid signal in the mastoid can be an incidental finding on T2-weighted magnetic resonance imaging and often is interpreted as mastoiditis by radiologists. 

A recent study examined 28 consecutive cases of such erroneously diagnosed "mastoiditis" and documents the presence or absence of otologic symptoms and clinical signs. They found a very low prevalence of otologic symptoms or pathology and no cases of mastoiditis in these patients, and they determined that magnetic resonance imaging is not an effective screening modality for mastoiditis.

Another study showed 61 % of children had one or more salient findings in their paranasal sinuses or mastoid cells. 48 % had mucosal swelling in their paranasal cavities, 25 % in their mastoid cells. The prevalence was higher among children less than 10 years of age (60 % and 42 %) and among children with current upper respiratory tract infection (71 % and 35 %). There was no correlation to a history of headache, snoring, asthma and allergies, or to gender or place of residence.

CONCLUSION:

Mucosal swelling in paranasal sinuses and in mastoid cells is a frequent incidental finding in adults and more commonly in children. Even major mucosal swelling in a paranasal sinus is not necessarily a sign of infection. In radiological reports the terms "sinusitis" and "mastoiditis" should therefore be used with great caution. The initiation of treatment should be based on clinical symptoms and not on radiological abnormalities alone.

The Northern Cochlear Implant Programme (NCIP)

The Northern Cochlear Implant Programme (NCIP) is a publicly funded programme for profoundly deaf children and adults in the northern region of New Zealand.

They have opened a new web-site with information on referral criteria for adults and children. 

http://www.ncip.org.nz/health-professionals.html#who-can-refer-to-the-ncip






Chris Cairns shares a moment with daughter Isabel, who has just received a cochlear implant and can hear for the first time.(Courtesy of stuff.co.nz and Canberra times)

Whangarei Hospital Adult Hearing Aid Service - Information & Guidelines for Referrers

Whangarei Hospital Adult Hearing Aid Service - Information & Guidelines for Referrers

Please refer patients for hearing aid services to the Audiology service rather than the ENT clinic. I also have added the criteria for the referral.

Information for Referrers (1)

Mycetoma Fungal Sinusitis

Fungal infections of the paranasal sinuses are uncommon and usually occur in individuals who are immunocompromised. However, recently, the occurrence of fungal sinusitis has increased in the immunocompetent population.

 There a number of different types of fungal sinusitis.
Allergic fungal sinusitis
Sinus mycetoma 
Acute invasive fungal sinusitis 
Chronic invasive fungal sinusitis 
Granulomatous invasive fungal sinusitis

Mycetoma Fungal Sinusitis produces clumps of spores, a "fungal ball," within a sinus cavity, most frequently the maxillary sinuses. Generally, the fungus does not cause a significant inflammatory response, but sinus discomfort occurs. The noninvasive nature of this disorder requires a treatment consisting of simple scraping of the infected sinus. An anti-fungal therapy is generally not prescribed. The other types of fungal sinusitis will be discussed in subsequent blogs.

Meningoencepholocoele- Endonasal treatment with nasoseptal flap

Meningoencephalocele is a type of encephalocele characterized by the protrusion of both meninges and brain tissue through a defect in the skull. 

There are two main types of meningoencephalocele. The more common frontoethmoidal type is located at the frontal and ethmoid bones while the occipital type is located at the occipital bone. Hydrocephalus, abnormalities of the eyeball and lacrimal duct  and other findings have been associated with the condition. Some affected individuals have intellectual disabilities .

 The condition is typically congenital  but rarely has been reported to occur spontaneously or after head trauma in older individuals (this occured in our patient shown in the video). The underlying cause of the condition is uncertain, but environmental factors are thought to play a role. 

Treatment depends on the size, location and severity of the defect but mainly includes surgery to repair the defect.
The video shows one of our authors (SS) using a local nasoseptal flap to seal the defect.