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Salvage surgery vs. repeat stereotactic radiosurgery for progressing vestibular schwannomas
This large multicentre case series of patients treated twice with stereotactic radiosurgery (SRS) for progressing vestibular schwannomas (VS) is reported by the International Gamma Knife Radiosurgery consortium. Progression of tumour growth after primary SRS is rare but does occur. Complications...
CRSwNP initiation, not always an interleukin fault
CRSwNP, similar to asthma, is an inflammatory disorder (type II) with eosinophilia and raised IL-5 and IL-13. Inflammation in CRSwNP is thought to be started by IL-25, IL-33 and thymic stromal lymphopoietin (TSLP), all of which form an important part...
Zinc and rhinosinusitis
Patients with chronic rhinosinusitis (CRS) in general, and those with nasal polyps (CRSwNP) in particular, have been shown to have down-regulation of tight junction genes. Zinc, on the other hand, is well-known for its role in immune regulation and deficiency...
Association of childhood OME with obesity
Many factors influence the development of otitis media with effusion (OME) in children, some of them being increased plasminogen factor inhibitor (PAI-1) levels, eustachian tube obstruction and gastro-oesophageal reflux. These factors are also associated with obesity. Sixty children with mean...
Neck dissection in adenoid cystic carcinoma is a risk worth taking?
This paper from Stanford University presents impressive figures to guide the debate on the extent of surgical management in adenoid cystic disease. Adenoid cystic carcinomas present a particular problem in that they can recur even after 20 years. They have...
Does endoscopic tympanoplasty give better results than a conventional approach?
This is a retrospective review looking at two groups of patients who had undergone middle ear surgery for chronic otitis media (perforation, retraction pocket/cholesteatoma) either open or endoscopic. Four hundred and five patients underwent open ear surgery and 501 endoscopic,...
Paediatric pituitary surgery - is it lagging behind?
Endoscopic sellar surgery, especially for adenomas, is a relatively safe, straightforward surgery with (mostly) reproducible results and few complications. However, the evolution of pituitary surgery was a long process, starting from open/transfrontal approaches all the way to transsphenoid to the...
The microbiological environment of the paranasal sinuses
This article reviews the ecology of the sinuses and tries to make sense of the confusing literature on the subject. This covers the details of molecular studies, particularly those which attempt to differentiate normal sinuses from those in patients with...
Maternal angst
This paper confirms the anxiety that a mother experiences when their child undergoes surgery. The paper focuses on adenoidectomy and adenotonsillectomy for moderate to severe upper airway obstruction showing admirably how anxiety reduces following surgery. The authors recruited 66 mothers...
Medical trends in sleep disordered breathing
This duo provide an eloquent outline of sleep disordered breathing in general, with particular emphasis on the medical impact and associations of the condition. The increasing prevalence of the condition is described, with increasing worldwide obesity, increased association of cardiac...
Not so innocent, after all: a meta-analysis of the effects of intranasal corticosteroids on growth
The use of intranasal corticosteroids has revolutionised the management of allergic rhinitis and rhinosinusitis and there is now significant evidence of their safety. The problem with side-effects is that clinical studies are designed to demonstrate efficacy, but are underpowered to...
