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Markey A, Workman VL, Bruce IA, Woolford TJ, Derby B, Miller AF, Cartmell SH, Saiani A. Peptide hydrogel in vitro non-inflammatory potential. J Pept Sci 2016; 23:148-154. [PMID: 27990715 PMCID: PMC5324702 DOI: 10.1002/psc.2940] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/20/2016] [Accepted: 10/25/2016] [Indexed: 02/04/2023]
Abstract
Peptide‐based hydrogels have attracted significant interest in recent years as these soft, highly hydrated materials can be engineered to mimic the cell niche with significant potential applications in the biomedical field. Their potential use in vivo in particular is dependent on their biocompatibility, including their potential to cause an inflammatory response. In this work, we investigated in vitro the inflammatory potential of a β‐sheet forming peptide (FEFEFKFK; F: phenylalanine, E: glutamic acid; K: lysine) hydrogel by encapsulating murine monocytes within it (3D culture) and using the production of cytokines, IL‐β, IL‐6 and TNFα, as markers of inflammatory response. No statistically significant release of cytokines in our test sample (media + gel + cells) was observed after 48 or 72 h of culture showing that our hydrogels do not incite a pro‐inflammatory response in vitro. These results show the potential biocompatibility of these hydrogels and therefore their potential for in vivo use. The work also highlighted the difference in monocyte behaviour, proliferation and morphology changes when cultured in 2D vs. 3D. © 2016 The Authors Journal of Peptide Science published by European Peptide Society and John Wiley & Sons Ltd.
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Affiliation(s)
- A Markey
- School of Materials, University of Manchester, Oxford Road M13 9PL, Manchester, UK
| | - V L Workman
- School of Materials, University of Manchester, Oxford Road M13 9PL, Manchester, UK.,Manchester Institute of Biotechnology, University of Manchester, Oxford Road M13 9PL, Manchester, UK
| | - I A Bruce
- Paediatric ENT Department, Royal Manchester Children's Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.,Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, M13 9PL, Manchester, UK
| | - T J Woolford
- Department of Otolaryngology-Head & Neck Surgery, Manchester Royal Infirmary, University of Manchester, Oxford Road, Manchester, M13 9WL
| | - B Derby
- School of Materials, University of Manchester, Oxford Road M13 9PL, Manchester, UK
| | - A F Miller
- Manchester Institute of Biotechnology, University of Manchester, Oxford Road M13 9PL, Manchester, UK.,School of Chemical Engineering and Analytical Science, University of Manchester, Oxford Road, M13 9PL, Manchester, UK
| | - S H Cartmell
- School of Materials, University of Manchester, Oxford Road M13 9PL, Manchester, UK
| | - A Saiani
- School of Materials, University of Manchester, Oxford Road M13 9PL, Manchester, UK.,Manchester Institute of Biotechnology, University of Manchester, Oxford Road M13 9PL, Manchester, UK
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2
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Broomfield S, Mawman D, Woolford TJ, O'driscoll M, Luff D, Ramsden RT. Non-auditory stimulation in adult cochlear implant users. Cochlear Implants Int 2013; 1:55-66. [DOI: 10.1179/cim.2000.1.1.55] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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3
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Ranganathan B, Woolford TJ. 'Scratch pad' technique for refinement of cartilage grafts in rhinoplasty and ear reconstructive surgery: a technical innovation. Clin Otolaryngol 2012; 37:166-7. [PMID: 22515721 DOI: 10.1111/j.1749-4486.2012.02461.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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4
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Siau D, List RJ, Hussin N, Woolford TJ. Do printed information leaflets improve recall of the procedure and risks in adult tonsillectomy? How we do it. Clin Otolaryngol 2011; 35:503-6. [PMID: 21199416 DOI: 10.1111/j.1749-4486.2010.02227.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- D Siau
- Central Manchester University Hospitals NHS Foundation Trust
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5
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Slater RM, Bhatia K, Woolford TJ, Nirmalan M. Anaesthetic airway management of subglottic stenosis in Wegener's Granulomatosis. Br J Anaesth 2011. [DOI: 10.1093/bja/el_7362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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6
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Nichani JR, Malik V, Woolford TJ, Ramsden RT, Homer JJ. The role of nervus intermedius in side specific nasal responses. Rhinology 2010; 48:23-7. [PMID: 20502731 DOI: 10.4193/rhin08.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nervus intermedius (NI) dysfunction is common in patients who have had vestibular schwannoma (VS) surgery. Such patients have a unilateral parasympathetic-denervated nasal cavity. A number of side-specific nasal reflexes have been demonstrated in normal individuals, including hand cold-water immersion. It is not understood whether these reflexes have parasympathetic or sympathic efferent pathways. We aimed to evaluate the side specific nasal reflex to cold-water immersion in post-operative VS patients with NI dysfunction, in order to determine the nature of the efferent pathway of these reflexes. METHOD Side specific responses to cold-water immersion were tested by acoustic rhinometry in 10 normal individuals and 18 patients with NI dysfunction (proven by Schirmer s test) after VS surgery. RESULTS A consistent pattern of ipsilateral congestion and contralateral decongestion after the cold-water immersion was seen in normal individuals (p smaller than 0.001). We found no consistent response in VS patients both ipsilateral and contralateral to the side of NI dysfunction. CONCLUSIONS We confirm the consistent side-specific nasal reflexes to cold-water hand immersion in normal individuals. This is disturbed in patients with NI dysfunction. We have also shown unexpectantly that the contralateral side-specific reflex is disturbed in these patients. These data suggest that the reflex is parasympathetic and crosses the midline.
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Affiliation(s)
- J R Nichani
- University Department of Otolaryngology-Head & Neck Surgery, Manchester Royal Infirmary, Oxford Rd, Manchester, United Kingdom
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7
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Abstract
Food allergy is often thought to be a cause of rhinitis by patients, whose views are frequently influenced by information obtained from the Internet. The incidence of food allergy in children is 2-8 per cent, although a vast majority will grow out of it, and food allergy is actually very rare in adults. Food allergy usually presents with multi-system involvement, most commonly cutaneous and gastrointestinal symptoms. Food allergy induced rhinitis is less common, and isolated rhinitis due to food allergy is extremely rare. Treatment for rhinitis due to food allergy is therefore rarely indicated. This review summarises the literature related to the incidence, diagnosis and management of food allergy and food allergy induced rhinitis.
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Affiliation(s)
- V Malik
- University Department of Otolaryngology-Head & Neck Surgery, Manchester Royal Infirmary, Manchester, UK.
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8
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Newton Ede MP, Hobson JC, Woolford TJ. Imaging in sinusitis. Br J Gen Pract 2006; 56:141-2. [PMID: 16464338 PMCID: PMC1828231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
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9
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Abstract
OBJECTIVES There is a recognized clinical association between nasal polyps and asthma. Nasal polyps and the airways of asthmatic patients demonstrate marked eosinophilia suggesting that this inflammatory cell may have a key role to play in both conditions. The objective of this study was to determine whether nasal polyps from patients with asthma had a greater density of activated eosinophils than patients with no associated respiratory disease. DESIGN Archived specimens were retrieved from patients who had undergone nasal polyp surgery and their case notes reviewed. Activated eosinophils were identified using immunohistochemistry for a monoclonal antibody to secreted eosinophil cationic protein (EG2). SETTING Teaching hospital otolaryngology unit. PARTICIPANTS Consecutive patients who had undergone nasal polyp surgery in 1994 were recruited. The diagnosis of asthma was based on a documented physician diagnosis and appropriate drug treatment. Twenty-four asthmatic and 35 non-asthmatic patients were studied. MAIN OUTCOME MEASURES Eosinophil density was measured using a standardized counting technique. RESULTS Asthmatic patients were significantly more likely to have had previous polyp surgery (chi-square test: P < 0.05). Areas of intense eosinophilia were identified in all samples. There was a significant greater degree of activated eosinophilia in the asthmatic patients (t-test: P < 0.05). CONCLUSIONS We have demonstrated a higher number of previous operations in asthmatic patients, and also a greater degree of activated eosinophilia in asthmatic polyps compared with non-asthmatics. This would suggest that eosinophil activity has a role to play in the pathogenesis of nasal polyps.
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Affiliation(s)
- N D Bateman
- Department of Otolaryngology, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK.
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Bateman ND, Shahi A, Feeley KM, Woolford TJ. Vascular endothelial growth factor in nasal polyps: a comparison of asthmatic and non-asthmatic patients. ACTA ACUST UNITED AC 2005; 29:677-81. [PMID: 15533158 DOI: 10.1111/j.1365-2273.2004.00901.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The cause of nasal polyps remains unknown, although there is a well-recognized clinical association between nasal polyposis and asthma. The characteristic histological features of nasal polyps include large quantities of extracellular fluid. Vascular endothelial growth factor (VEGF) is a potent mediator of angiogenesis and vascular permeability. This study aimed to compare expression of VEGF in nasal polyps from patients with asthma and those with no apparent respiratory disease. Twenty-four asthmatic and 35 non-asthmatic patients were studied using immunohistochemistry for VEGF. VEGF expression was identified in endothelial, inflammatory and epithelial cells. There was significantly greater endothelial expression of VEGF in asthmatic patients (P < 0.05). Greater epithelial expression was observed in asthmatic patients but this did not reach statistical significance (P = 0.07). There was no difference in the density of inflammatory cells expressing VEGF. Differences between the two groups may reflect differences in disease severity or in the nature of the inflammatory process.
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Affiliation(s)
- N D Bateman
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, UK.
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11
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Wu K, Ahmed A, Woolford TJ. Treatment of home oxygen induced rhinitis: an unusual use for a nasal obturator. Rhinology 2004; 42:244-5. [PMID: 15626260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Patients requiring home oxygen can experience drying and crusting of nasal mucosa. On occasion it can be severe causing significant discomfort. In this report we present such a case. To prevent nasal airflow and hence reduce symptoms the patient was fitted with a nasal obturator. The use of the nasal obturator resulted in a rapid resolution of her symptoms. In this case the use of the nasal obturator was reversible and a simple solution for the treatment of a difficult condition.
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Affiliation(s)
- K Wu
- Department of Otolaryngology, Royal Hallamshire Hospital, Glossop Road, Sheffield, United Kingdom.
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12
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Abstract
Patients often present to otolaryngologists with nasal symptoms where no cause is apparent. A number of patients seen in outpatient departments are taking medication for other conditions and the adverse affects of these drugs may potentially be the source of these symptoms. In this short review, we present an overview of the more common drugs that may be responsible and outline the possible mechanisms where these are known.
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Affiliation(s)
- N D Bateman
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, UK.
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13
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Abstract
Epistaxis is one of the most frequently managed otorhinolaryngological emergencies. This prospective study over a 4-month period involved 38 adult patients presenting with epistaxis who underwent endoscopic bipolar diathermy under local anaesthesia. Thirty-four (89%) of the 38 adults were successfully treated and 28 (74%) of the patients did not require admission. Based on a simple cost-benefit analysis of savings made by avoiding admission, successful immediate treatment of these 28 patients led to a potential saving of at least pound 6804.00. We conclude endoscopic bipolar diathermy under local anaesthesia is an effective, safe and cost-efficient modality of treatment in the management of adult epistaxis.
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Affiliation(s)
- A Ahmed
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, UK
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14
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Kayarkar R, Woolford TJ, Francis GA. Simple preoperative assessment to reduce the risk of traumatic epistaxis during nasotracheal intubation. Eur J Anaesthesiol 2003; 19:690-1. [PMID: 12243297 DOI: 10.1017/s0265021502251133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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15
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Abstract
Informed consent is becoming an increasingly important issue in patient care. Inherent in this is the ability to accurately inform patients of the risks and complications involved in surgery. Nasal septal surgery is commonly performed by otolaryngologists and although often considered routine has a number of recognized complications that can have a significant effect on life quality. We carried out a review of the literature over the last 25 years and reviewed studies quoting rates of complications after septoplasty and submucous resection (SMR) using strictly applied criteria for study inclusion. There was a paucity of prospective data, especially for the cosmetic effects of septal surgery. Rates of septal perforation were two to eight per cent for SMR and 1.6-5.4 per cent for septoplasty. The incidence of cosmetic deformity was low for both procedures zero to one per cent. More well-designed studies are required to augment the current evidence base. While this does not replace the need for surgeons to audit their own results it provides evidence-based information to assist in the process of informed consent.
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Affiliation(s)
- N D Bateman
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, UK
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16
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Abstract
Computed tomography (CT) is the imaging method of choice for conditions that affect the paranasal sinuses. We reviewed all paranasal CT scans in the ear nose and throat (ENT) and maxillofacial surgery departments in 1 year. Of these 372 scans, unilateral opacity of the maxillary sinus was seen in 20 cases. Neoplastic disease was diagnosed in six of these, four of which were malignant. We describe the cases of neoplastic disease, particularly features of the history, examination, and scans that should alert the clinician to the possibility of sinister pathology. We emphasise the importance of nasendoscopic examination in the accurate assessment of sinonasal disease.
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Affiliation(s)
- M Rudralingam
- Department of Oral and Maxillofacial Surgery, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
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17
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Bateman ND, Whymark AD, Clifton NJ, Woolford TJ. A study of intranasal distribution of azelastine hydrochloride aqueous nasal spray with different spray techniques. Clin Otolaryngol Allied Sci 2002; 27:327-30. [PMID: 12383290 DOI: 10.1046/j.1365-2273.2002.00589.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Topical aqueous nasal sprays are widely used in treating patients with a variety of nasal diseases. Previous studies have suggested that drug delivery to the ciliated mucosa is generally suboptimal. Little is known about the effects of nasal spray delivery technique on intranasal distribution and efficacy of topical nasal drugs. We assessed the intranasal distribution of a nasal spray with two commonly used techniques using azelastine hydrochloride labelled with fluorescein. After spraying, the nasal cavity was photographed endoscopically in two standardized positions, one showing the anterior portion in the region of the nasal valve and one the area of the middle meatus. The photographs were computer analysed to identify the proportion of coverage of fluorescein in each image field. The majority of drug was distributed anteriorly with poor coverage posterior to the nasal valve area. This was the case with both of the positions tested.
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Affiliation(s)
- N D Bateman
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Glossop Road, Sheffield, UK.
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18
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Abstract
Epistaxis associated with hereditary haemorrhagic telangiectasia (HHT) is a challenging condition. Septodermoplasty, electrocautery and laser treatment often provide short-term relief only. The surgical closure of the nostrils ('Young's procedure') represents a longer term solution but has the disadvantage of causing permanent complete nasal obstruction. A Silastic obturator has the advantage of being a non-surgical intervention and allows temporary relief of the nasal obstruction. We present the cases of three patientswith HHT who used the obturator with good clinical effect, suggesting that this is a realistic non-surgical alternative to Young's procedure for patients with HHT.
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Affiliation(s)
- T J Woolford
- Department of Otorhinolaryngology-Head and Neck Surgery, Royal Hallamshire Hospital, Sheffield, UK
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19
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Abstract
Steroid nose drops are used frequently to treat rhinosinusitis and nasal polyposis. The middle meatal area is of key importance in the pathophysiology of these conditions. This study assesses which of three head positions commonly used to instil nose drops resulted in the highest coverage of this area. Discomfort levels were also studied using a visual analogue scale for each position. Five volunteers were studied in: (i) head back (HB); (ii) head forward and down (HFD); and (iii) lying head back (LHB) positions. Betamethasone nose drops, dyed with fluorescein, were instilled into each nostril and the distribution was studied endoscopically. The middle meatus area distribution was highest in the LHB position (55.51%), followed by HFD (31.55%) and HB (6.87%) positions. Comparison of distribution between HB and LHB (P = 0.002) and between HB and HFD (P = 0.045) was statistically significant. The HFD position was most uncomfortable (mean discomfort score 8.8) whereas the HB (2.4) and LHB (2.6) were similar. The LHB would, therefore, appear to be the most suitable position for instillation of steroid nose drops.
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Affiliation(s)
- R Kayarkar
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, UK.
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20
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Abstract
Adult nasal dermoid cysts and sinuses are rare. Here we describe the surgical management of a 37-year-old patient with a longstanding nasal dermoid cyst and discharging sinus. A combination of an open rhinoplasty approach with a small dorsal incision was used to excise the lesion followed by primary reconstruction with septal cartilage.
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Affiliation(s)
- D K Loke
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, UK
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21
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Abstract
In this presentation we examine the practice of high ear-piercing in children, the issue of informed consent and current legislation. We sampled current practice and consent policy by visiting nine establishments in Sheffield providing this service. There were two high street department stores, two fashion accessory outlets and five body-piercing studios. Enquiries were made as to the technique used, knowledge of complications, customer counselling and consent policy. A photograph of an ear with a cosmetic deformity following high ear-piercing was shown and awareness of this possible outcome was noted. Two ear-piercing techniques were identified, either a spring-loaded gun firing a blunt stud or the use of a body-piercing needle. The fashion accessory outlets were prepared to pierce any part of the ear using a spring-loaded gun in children under 16 years of age. There was a general lack of knowledge about possible serious complications. Two of the body piercers would not perform high ear-piercing on clients under the age of 16 years. The body piercers use a disposable needle and were of the opinion that using a spring-loaded gun shatters the cartilage and increases the risk of infection. The best technique is open to debate and it may be that the perceived unsavoury environment of the body-piercing studio represents a safer option than the more respectable or cheaper alternatives. The practice of body piercing in the UK remains uncontrolled.
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Affiliation(s)
- P N Jervis
- Department of Otolaryngology, Royal Hallamshire Hospital, Sheffield, UK
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22
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Abstract
The surgical closure of a nasal septal perforation is recognized as being particularly challenging. A series of 11 consecutive patients who underwent closure of a septal perforation using a mucosal flap/composite conchal cartilage graft technique are reviewed, and the surgical technique described. The size of the perforation repaired varied, with eight cases being 2 cm or more in diameter. There was no significant graft donor site morbidity and complete perforation closure was achieved in eight cases after a mean observation time of 19.8 months. These results suggest that this is a suitable technique for closing nasal septal perforation.
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Affiliation(s)
- T J Woolford
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, UK
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23
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Abstract
Arterial ligation of the anterior ethmoidal artery may be required in cases of persistent epistaxis and conventional techniques involving open surgery carry a recognized morbidity. We describe an endoscopic, intranasal technique for ligation of the anterior ethmoidal artery. This technique was performed in a patient who had a severe epistaxis following nasal trauma. Her epistaxis persisted in spite of anterior and posterior nasal packing. Endoscopy showed the bleeding to originate high and lateral to the middle turbinate. Endoscopic exploration defined the frayed end of the anterior ethmoidal artery. A ligaclip was placed with immediate and persistent arrest of her epistaxis. No further nasal packs or treatment were required.
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Affiliation(s)
- T J Woolford
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, UK
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24
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Woolford TJ, Ahmed A, Willatt DJ, Rothera MP. Spontaneous resolution of tonsillitis in children on the waiting list for tonsillectomy. Clin Otolaryngol Allied Sci 2000; 25:428-30. [PMID: 11012659 DOI: 10.1046/j.1365-2273.2000.00402.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study was to determine whether children undergo spontaneous resolution of recurrent acute tonsillitis whilst awaiting surgery. Eighty children who had been on the waiting list for tonsillectomy for at least 9 months were requested to attend a review clinic with a second review 6 months later if appropriate. Nineteen (27%) of the 70 children who completed the study no longer warranted surgery and were removed from the waiting list. We conclude that those children who have been on the waiting list for a long period of time should be reassessed prior to the planned tonsillectomy to see if surgery is still indicated.
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Affiliation(s)
- T J Woolford
- Department of Otolaryngology, Royal Manchester Children's Hospital, Manchester, UK
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25
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Abstract
A concha bullosa may require surgical reduction to facilitate access to the middle meatus during endoscopic sinus surgery. Here we describe an original instrument which enables this procedure to be performed simply with minimal mucosal damage.
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Affiliation(s)
- T J Woolford
- Department of Otorhinolaryngology, Royal Hallamshire Hospital, Sheffield, UK
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26
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Abstract
We describe the technique of implant-site split-skin grafting for the bone-anchored hearing aid (BAHA). Twenty-five patients have undergone this procedure (20 adults and five children) since 1993 with a minimum follow-up of 1 year. Fifteen adults were operated upon as single stage surgery, all other cases (including all children) were performed in two stages. In four patients (16%) significant early graft inflammation was encountered which settled with outpatient treatment. In one the abutment had to be temporarily removed to allow the graft to settle. All patients now have a stable graft site. This surgical technique is straightforward and a separate graft donor site is avoided. It would appear this technique results in a stable BAHA graft site with low associated morbidity.
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Woolford TJ, Hanif J, Washband S, Hari CK, Ganguli LA. The effect of previous antibiotic therapy on the bacteriology of the tonsils in children. Int J Clin Pract 1999; 53:96-8. [PMID: 10344042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
The bacteriology of the tonsillar surface and core in 30 children undergoing tonsillectomy was studied. Antibiotics taken in the six months before surgery were recorded. Haemophilus influenzae and Staphylococcus aureus were the commonest isolates; Streptococcus pyogenes was relatively rare. Eight children had received no antibiotics, the others had been prescribed 65 different courses of 13 different types. No relationship between the various antibiotic regimens prescribed and tonsillar bacteriology could be demonstrated, and it would appear that the tonsillar bacteriology at the time of tonsillectomy is not altered by antibiotics prescribed in the previous six months.
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Affiliation(s)
- T J Woolford
- Department of Otolaryngology, Royal Manchester Children's Hospital
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28
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Axon PR, Woolford TJ, Hargreaves SP, Yates P, Birzgalis AR, Farrington WT. A comparison of surgery and radiotherapy in the management of post-cricoid carcinoma. Clin Otolaryngol 1997; 22:370-4. [PMID: 9298615 DOI: 10.1046/j.1365-2273.1997.t01-1-00008.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
One hundred and forty-three patients with post-cricoid squamous cell carcinoma are described. Twenty-nine patients (20%) underwent pharyngolaryngoesophagectomy with gastric transposition. Forty-four patients (31%) were treated with radical radiotherapy and 70 (49%) had palliative therapy. Kaplan Meier 5-year survival following surgery was 45% and radiotherapy was 23%. The presence of nodal disease at presentation was the most significant prognostic factor. The 5-year survival of patients undergoing surgery with no palpable lymph node spread at presentation was 63% which compared with 25% following radiotherapy. This difference was statistically significant (P = 0.0153, Logrank test stratified by nodal status). Patients with palpable metastatic nodal spread at presentation had 5-year survivals of 10% and 0% in the surgical and radiotherapy groups respectively. This study demonstrates that patients with post-cricoid carcinoma who present without palpable lymph node spread have a significant improved 5-year survival following surgery when compared with radiotherapy.
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Affiliation(s)
- P R Axon
- Department of Otolaryngology, Manchester Royal Infirmary, UK
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29
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Abstract
The adult cochlear implant programme in Manchester was established in 1988 and the evaluation of the cochlear implant service involved the first 58 implants users (mean age = 51.65 years, range 19-75 years). Questionnaires were sent to implant users and their partners to evaluate the service with regard to provision of information, clinical care during in-patient assessments, waiting times, operation for cochlear implant and post-operative rehabilitation. The results show that the majority of patients (78 per cent) felt that the implant gave them as much or more benefit than expected. Areas identified for improvements include provision of more written information about cochlear implants; reduction in waiting times for first appointments; more information about the surgical risks and more instruction about home auditory training exercises for family and friends. As a consequence of the audit results the clinical practice and service provision for cochlear implantation in Manchester has been modified.
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Affiliation(s)
- D J Mawman
- Manchester Cochlear Implant Programme, The University, Manchester, UK
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30
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Abstract
This study was performed to assess the survival times of the Provox valve in the Manchester area. Thirty-nine patients from four hospitals, representing 81 valve failures, were studied. The effects of the timing of the tracheo-oesophageal puncture, previous radiotherapy, and the presence and timing of cricopharyngeal myotomy on valve life were analysed. Regression analysis using an extension of the Cox model to allow strata showed that the lifetime of the first valve only is adversely affected by previous radiotherapy. The other covariates do not have a statistically significant effect on valve survival. The median valve survival is 4.5 months, (range one to 12 months). A small percentage of valve users with particularly frequent valve failures may require additional support and prolonged anti-fungal therapy.
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Saeed SR, Ramsden RT, Hartley C, Woolford TJ, Boyd P. Cochlear reimplantation. J Laryngol Otol 1995; 109:980-5. [PMID: 7499953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Since its inception in 1988 the Cochlear Implant Programme in Manchester has successfully implanted 69 adults and 23 children. Of these 92 procedures, three patients have undergone revision surgery with the insertion of either a new implant or re-positioning of the existing device. We examine the circumstances that lead to the need for reimplantation in these patients, discuss the technical aspects of revision surgery together with the functional results of such procedures.
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Affiliation(s)
- S R Saeed
- University Department of Otolaryngology, Manchester Royal Infirmary
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Woolford TJ, Roberts GR, Hartley C, Ramsden RT. Etiology of hearing loss and cochlear computed tomography: findings in preimplant assessment. Ann Otol Rhinol Laryngol Suppl 1995; 166:201-206. [PMID: 7668637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Patients being considered for cochlear implantation undergo, of necessity, a wide-ranging selection process, of which imaging of the temporal bone to assess cochlear patency is an important part. We have studied the correlation between the results of computed tomography (CT) imaging of the cochlea and the cause of hearing loss in this group of patients. The CT scans of 105 patients were reviewed. Of these, 74 (70%) were normal, with the commonest abnormalities being labyrinthitis ossificans in 14 (13.3%) cases and capsular rarefaction in 10 (9.5%) cases. A congenital abnormality was seen in 4 (3.8%) cases and temporal bone fractures in 2 (1.9%) cases; 1 patient had previously undergone a labyrinthectomy. In 25 patients the cause of the hearing loss was known to be meningitis. Of these patients, 15 had normal scans and 10 showed labyrinthitis ossificans. Of note is that none of the 6 patients with tuberculous meningitis had abnormal scans. There was a high correlation between a rarefied capsule on CT imaging and a diagnosis of otosclerosis, with 6 out of 7 otosclerosis patients demonstrating this abnormality. Evidence of a previous temporal bone fracture was seen on the scans of only 2 out of 6 patients in whom the cause of deafness was thought to be severe head injury.
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Affiliation(s)
- T J Woolford
- Department of Otolaryngology, Manchester Royal Infirmary, England
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Woolford TJ, Saeed SR, Boyd P, Hartley C, Ramsden RT. Cochlear reimplantation. Ann Otol Rhinol Laryngol Suppl 1995; 166:449-53. [PMID: 7668748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Since its inception in 1988, the Cochlear Implant Programme in Manchester has successfully implanted 61 adults and 15 children. Of these 76 patients, 3 have undergone revision surgery, and these cases are presented. One patient was a 43-year-old blind man who underwent routine implantation with a Nucleus device. Six weeks after implantation the patient experienced sudden device failure following an electric shock from a domestic appliance. The patient was reimplanted with a similar device 3 weeks later and is making good progress. Assessment of the original implant showed a failure of one of the capacitors in the receiver-stimulator circuit. The second patient was a 51-year-old woman who underwent routine implantation with a Nucleus 22-channel device. The patient's audiologic performance fluctuated, and 14 months after the original procedure the patient was reimplanted. Analysis by the manufacturer suggested that the original implant was unstable at higher temperatures. The third patient, a 55-year-old woman, was implanted with an Ineraid multichannel device into the right cochlea. A postoperative radiograph showed the implant to be incorrectly positioned, and the procedure was revised 4 weeks later. Here it was found that the electrode system was running across the promontory, toward the eustachian tube orifice. This was reimplanted with satisfactory results.
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Affiliation(s)
- T J Woolford
- University Department of Otolaryngology, Manchester Royal Infirmary, England
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Saeed SR, Woolford TJ, Ramsden RT, Lye RH. Magnetic resonance imaging: a cost-effective first line investigation in the detection of vestibular schwannomas. Br J Neurosurg 1995; 9:497-503. [PMID: 7576276 DOI: 10.1080/02688699550041133] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Magnetic resonance imaging (MRI) is currently the 'gold-standard' investigation in patients with a unilateral sensorineural hearing loss. The procedure, however, is expensive and of limited availability. Instead, such patients often undergo a series of audiovestibular tests and computed tomography in an attempt to exclude or diagnose a vestibular schwannoma. We describe seven cases of unilateral vestibular schwannoma in which conventional assessment was either equivocal or failed to demonstrate a tumour subsequently diagnosed by magnetic resonance imaging. Two patients with neurofibromatosis type 2 are also reported to show how magnetic resonance imaging confirmed the presence of a second vestibular schwannoma despite CT that showed only a unilateral lesion. We also illustrate how limited protocol MRI of patients is slightly more expensive yet much more cost effective than the usual battery of tests and propose that it should be the first line investigation for patients in whom the clinical picture requires exclusion of a retrocochlear lesion. Not all of these early diagnosed tumours have been immediately removed. In some of the more elderly or infirm patients a 'wait and rescan' policy has been adopted. Nevertheless, the early establishment of the correct diagnosis facilitates the subsequent management of these patients.
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Affiliation(s)
- S R Saeed
- University Departments of Otolaryngology, Manchester, UK
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Woolford TJ, Toriumi DM. The enhancement of nerve regeneration using growth factors: a brief review. J Long Term Eff Med Implants 1994; 5:19-26. [PMID: 10163506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
The management of peripheral nerve injuries continues to challenge the surgeon. Despite advances in surgical technique, return of normal function is uncommon after the repair of a transected nerve. It is now possible to enhance the process of nerve regeneration in animals using growth factors carried in silicone nerve guides. In this article the biological process of nerve regeneration is described and contemporary research involving the use of growth factor implants to facilitate nerve regeneration is reviewed.
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Affiliation(s)
- T J Woolford
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Illinois at Chicago, IL 60612, USA
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Woolford TJ, Birzgalis AR, Ramsden RT. An extensive vestibular schwannoma with both intracranial spread and lateral extension to the external auditory canal. J Laryngol Otol 1994; 108:149-51. [PMID: 8163918 DOI: 10.1017/s0022215100126131] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
An extensive schwannoma in a 54-year-old woman is described. There was extension intracranially to involve the brain stem, laterally to fill the middle ear and external meatus, and inferiorly into the infratemporal fossa. Initially the intracranial portion of the tumour was excised. Later a second operation was undertaken to remove the residual tumour from the temporal bone and infratemporal fossa.
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Affiliation(s)
- T J Woolford
- University Department of Otolaryngology, Manchester Royal Infirmary
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Abstract
Spontaneous perforation of the oesophagus is extremely rare in children, as is perforation due to vomiting in pregnancy. We report the case of a 15-year-old in whom vomiting in early pregnancy resulted in oesophageal perforation with subcutaneous emphysema causing marked facial swelling in the absence of other signs. The more common clinical presentation of spontaneous oesophageal rupture (Boerhaave's syndrome) is discussed.
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Affiliation(s)
- T J Woolford
- University Department of Otolaryngology, Manchester Royal Infirmary
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Saeed SR, Timms MS, Woolford TJ. Cannabis in the ear--the legal aspects. J Laryngol Otol 1993; 107:979. [PMID: 8263407 DOI: 10.1017/s0022215100125034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Abstract
Medical photography is shown to have therapeutic value in illustrating to a patient a previously hidden clinical lesion. The sight of the extent and nature of a hole in her nasal septum which the patient had caused by picking her nose allowed her to stop this habit where previous medication and psychotherapy had failed.
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Affiliation(s)
- J D Bennett
- University Department of Otolaryngology, Manchester Royal Infirmary, UK
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Abstract
A total of 235 toes were amputated during 125 operations on 100 consecutive patients with lower limb ischaemia. The overall amputation wound healing rate for the series was 58.4 per cent and limb salvage was achieved in 66 patients. Toe amputation was performed under local anaesthesia in 57 cases and 32 (56 per cent) of these healed primarily, not significantly different from the healing rate of 41 (60 per cent) of 68 under general anaesthesia. Reconstructive arterial surgery was performed in conjunction with toe amputation in 39 patients; the healing rate with reconstruction was 32 (82 per cent) of 39, significantly better than the 41 (48 per cent) of 86 patients not undergoing bypass surgery (P less than 0.001). There was no difference in healing rates when comparing diabetic and non-diabetic patients. Multiple regression analysis demonstrated that reconstructive arterial surgery was the only factor which had an independent and significant influence on toe amputation healing. The use of local anaesthesia for distal amputation has no deleterious effects on wound healing.
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Affiliation(s)
- R L Byrne
- Department of Surgery, Derbyshire Royal Infirmary, UK
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