Sub-labial packing: a novel method of stopping epistaxis from Little's area

Epistaxis is frequently managed both by patients in the community and by health professionals. Many methods have been described in the literature about how to manage this condition. Epistaxis is usually due to anterior circulation bleeding at an area known as Kiesselbach's plexus (Little's area). Five vessels supply Little's area; one of these, the septal branch of the superior labial artery, can be compressed via an easy and novel technique, sub-labial packing. Sub-labial packing is a technique proposed as an adjunct to the standard 15 min ala nasi compression as a simple yet effective technique to stop epistaxis. We hereby report two cases of managing epistaxis from Little's area using sub-labial packing.

Bacterial biofilm adherence to middle-ear ventilation tubes: scanning electron micrograph images and literature review

Introduction: The organisms that cause many device-related and other chronic infections actually grow in biofilms in or on these devices. We sought to examine the role of biofilm formation in chronic middle-ear ventilation tube infection.

Case report: Scanning electron micrograph images are presented which demonstrate biofilm on a middle-ear ventilation tube removed from a five-year-old child's chronically discharging ear. A review of the relevant international literature explores the role of biofilms in chronic infection and discusses potential intervention strategies.

Conclusion: Biofilms may be responsible for chronic middle-ear ventilation tube infection that resists treatment with conventional antibiotics.

Pass/fail criteria in screening for otitis media in children with learning disorders

A group of 75 children with language/learning disorders were screened for middle ear problems using serial tympanometry and otoscopy. Using a fail criterion of -200 mm H2O for tympanometry, 68% of the ears identified as pathological by otoscopy were identified by two serial tympanometry screens. The concurrence of otoscopy and serial tympanometry indicated a failure rate of 18% of the ears tested. It is concluded that for children in special populations, such as those with language/learning disorders, who may need careful monitoring for identification of middle ear problems, a combination of otoscopy and a single test of tympanometry may improve the reliability of screening programs.