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Background and Purpose: Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders, and is treated effectively with particle repositioning maneuvers (PRM). The aim of this study was to assess the influence of BPPV and treatment effects of PRM on gait, falls, and fear of falling. Methods: Three databases and the reference lists of included articles were systematically searched for studies comparing gait and/or falls between (1) people with BPPV (pwBPPV) and controls and (2) pre- and posttreatment with PRM. The Joanna Briggs Institute critical appraisal tools were used to assess risk of bias. Results: Twenty of the 25 included studies were suitable for meta-analysis. Quality assessment resulted in 2 studies with high risk of bias, 13 with moderate risk, and 10 with low risk. PwBPPV walked slower and demonstrated more sway during tandem walking compared with controls. PwBPPV also walked slower during head rotations. After PRM, gait velocity during level walking increased significantly, and gait became safer according to gait assessment scales. Impairments during tandem walking and walking with head rotations did not improve. The number of fallers was significantly higher for pwBPPV than for controls. After treatment, the number of falls, number of pwBPPV who fell, and fear of falling decreased. Discussion and Conclusions: BPPV increases the odds of falls and negatively impacts spatiotemporal parameters of gait. PRM improves falls, fear of falling, and gait during level walking. Additional rehabilitation might be necessary to improve gait while walking with head movements or tandem walking. Video Abstract available for more insights from the authors (see the Supplemental Digital Content Video, available at: http://links.lww.com/JNPT/A421). [ABSTRACT FROM AUTHOR]

Summary Background Laryngeal involvement in inflammatory bowel disease is rare. Only 12 cases of laryngeal involvement in Crohn disease have been reported until now. Moreover, only one case of laryngeal manifestations in ulcerative colitis has been reported so far. Materials and Methods In this article, we present a patient with ulcerative colitis, who consulted our ear, nose, and throat (ENT) clinic with laryngeal complaints. Furthermore, a review of current literature was performed. Results A concise overview of this rare extraintestinal manifestation and other ENT manifestations of inflammatory bowel diseases is provided. Conclusions Laryngeal manifestations in inflammatory bowel disease are very rare, but these manifestations should be known by the otorhinolaryngologist. [ABSTRACT FROM AUTHOR]

Slow dissociation of endothelin 1 from its endothelin A receptors is responsible for the long-lasting vasoconstrictor effects of the peptide. We showed recently that calcitonin gene-related peptide selectively terminates long-lasting contractile responses to endothelin 1 in isolated rat mesenteric arteries. Here we assessed whether the antiendothelinergic effect of calcitonin gene-related peptide is vascular bed specific and may terminate long-lasting pressor responses to exogenous and locally produced endothelin 1 in vivo. Regional heterogeneity of the calcitonin gene-related peptide/endothelin A receptor cross-talk was explored in arteries isolated from various rat organs. Endothelin A receptor-mediated arterial contractions were terminated by calcitonin gene-related peptide in rat mesenteric, renal, and spermatic arteries but not in basilar, coronary, epigastric, gastric, splenic, and saphenous arteries. Endothelin A receptor antagonism only ended endothelin 1-induced contractions in spermatic arteries. In anesthetized rats, instrumented with Doppler flow probes to record regional blood flows, long-lasting pressor and vasoconstrictor responses to an intravenous bolus injection of endothelin 1 or big endothelin 1 were transiently reduced by sodium nitroprusside (NO donor) but terminated by intravenously administered calcitonin gene-related peptide. In conscious rats, calcitonin gene-related peptide but not sodium nitroprusside terminated prolonged (>60-minute) pressor responses to endothelin 1 but not those to intravenous infusion of phenylephrine. In conclusion, pressor responses to circulating and locally produced endothelin 1 that are resistant to endothelin receptor antagonism and NO can be terminated by a regionally selective effect of calcitonin gene-related peptide. Calcitonin gene related peptide receptor agonism may represent a novel strategy to treat endothelin 1-associated cardiovascular pathologies. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the effect of pelvic floor muscle training on the efficacy of full spectrum therapy and maximal voided volume in children with nocturnal enuresis. We also determined factors predicting treatment outcome, full spectrum therapy duration and the relapse rate. Full spectrum therapy is a combination of alarm, reward, timed voiding and drinking, over learning and pelvic floor muscle training. Materials and Methods: A total of 63 consecutive children were referred to the physiotherapy department for full spectrum therapy to resolve nocturnal enuresis, including 32 in the experimental group who underwent full spectrum therapy with pelvic floor muscle training and 31 in the control group who underwent full spectrum therapy without training. Results: There was no significant difference in treatment outcome, duration, maximal voided volume and relapse between the 2 groups. Of all children 89% became dry within 6 months. During the year after treatment 33.3% and 37.9% of the experimental and control groups relapsed, while the relapse rate at 1 year was 7.4% and 20.7%, respectively. Age and child motivation were associated with the duration of success (p = 0.04 and <0.01, respectively). Secondary enuresis and psychosocial problems were factors significantly related to relapse (each p <0.01). Conclusions: There is no beneficial effect of including pelvic floor muscle training in full spectrum therapy. Older children and those with better motivation experienced more rapid success. Factors predicting relapse were secondary enuresis and psychosocial problems. [Copyright &y& Elsevier]

Unexpected overnight stay following ENT day-case surgery: a 5-year audit., Problems/objectives: Recent decades have seen a steady reduction in the average duration of hospitalization for all surgical patients, including those undergoing ENT procedures. Correspondingly, the proportion of day surgeries relative to in-patient surgeries has progressively increased. In the present observational study, we aimed to evaluate the proportion of unplanned overnight stays following planned day surgeries in our ENT unit, and the major causes of these unexpected overnight admissions., Methods: From databases, we collected data from all patients who underwent ENT day-case surgery in Ziekenhuis Oost- Limburg between January 2008 and December 2013., Results: A total of 10,440 patients underwent ENT day-case surgery during this period. The overall rate of unexpected overnight admission was 1.86%, with these overnight admissions most commonly due to anaesthetic (46.91%), surgical (19.59%), and organizational (17.01%) reasons. The types of ENT surgery at the greatest risk for prolonged hospitalisation were hemithyroidectomy (12.50%), tympanoplasty (12.15%), and uvulopalatopharyngoplasty (UPPP) (7.81%). We further identified a clear difference in the rate of unexpected overnight stay between surgery scheduled in the morning (1.17%) versus in the afternoon (12.98%)., Conclusions: Our present findings highlight the various reasons for unexpected overnight admission after day-case surgery. To reduce the rate of unexpected overnight stays, we need to better understand these different reasons to support the ongoing search for possible solutions.

Facial trauma. Patients with facial trauma must be assessed in a systematic way so as to avoid missing any injury. Severe and disfiguring facial injuries can be distracting. However, clinicians must first focus on the basics of trauma care, following the Advanced Trauma Life Support (ATLS) system of care. Maxillofacial trauma occurs in a significant number of severely injured patients. Life- and sight-threatening injuries must be excluded during the primary and secondary surveys. Special attention must be paid to sight-threatening injuries in stabilized patients through early referral to an appropriate specialist or the early initiation of emergency care treatment. The gold standard for the radiographic evaluation of facial injuries is computed tomography (CT) imaging. Nasal fractures are the most frequent isolated facial fractures. Isolated nasal fractures are principally diagnosed through history and clinical examination. Closed reduction is the most frequently performed treatment for isolated nasal fractures, with a fractured nasal septum as a predictor of failure. Ear, nose and throat surgeons, maxillofacial surgeons and ophthalmologists must all develop an adequate treatment plan for patients with complex maxillofacial trauma.

Follicular regulatory T cells (TFR) have been extensively characterized in mice and participate in germinal center responses by regulating the maturation of B cells and production of (auto)antibodies. We report that circulating TFR are phenotypically distinct from tonsil-derived TFR in humans. They have a lower expression of follicular markers, and display a memory phenotype and lack of high expression of B cell lymphoma 6 and ICOS. However, the suppressive function, expression of regulatory markers, and FOXP3 methylation status of blood TFR is comparable with tonsil-derived TFR. Moreover, we show that circulating TFR frequencies increase after influenza vaccination and correlate with anti-flu Ab responses, indicating a fully functional population. Multiple sclerosis (MS) was used as a model for autoimmune disease to investigate alterations in circulating TFR. MS patients had a significantly lower frequency of circulating TFR compared with healthy control subjects. Furthermore, the circulating TFR compartment of MS patients displayed an increased proportion of Th17-like TFR. Finally, TFR of MS patients had a strongly reduced suppressive function compared with healthy control subjects. We conclude that circulating TFR are a circulating memory population derived from lymphoid resident TFR, making them a valid alternative to investigate alterations in germinal center responses in the context of autoimmune diseases, and TFR impairment is prominent in MS., (Copyright © 2015 by The American Association of Immunologists, Inc.)

Mucocutaneous leishmaniasis of the nose: a case report. Leishmaniasis is a parasitic infection that is rarely seen in Belgium. The majority of new diagnoses are seen in patients living in or visiting endemic regions, which are mostly developing countries. Here we describe the case of a 60-year-old male patient who was referred to an ENT specialist because of an erythematous swelling of the left side of the nose tip, which had persisted for 3 months. Biopsies showed the presence of leishmaniasis. This case report alerts ENT physicians that leishmaniasis is part of the differential diagnosis in patients who present with an uncommon persistent lesion in the head and neck region and who have travelled to endemic regions or are immunodeficient.

Objective: To give an overview of ear, nose, and throat (ENT) pathologies encountered in the emergency room (ER)., Methods: Retrospective analysis of 1296 files of patients visiting the ER between January 2008 and December 2012. Diagnosis, treatment, hospitalisation, referral, and demographic parameters were evaluated., Results: Epistaxis is the most frequent ENT condition seen in the ER. One third of epistaxis patients are on anticoagulant therapy. The second most frequent conditions observed were infections of the pharynx and tonsils. Nasal fractures and vertigo were also frequently observed., Conclusion: Epistaxis and its treatment were the most frequent ENT diagnosis and therapy seen in the ER. Infections are the main cause of hospitalisation. Referral to other disciplines and revisits seldom occurred.

Objectives: Research shows that 51.4% of adverse events in hospitals occur in surgery and that 3-22% of surgical patients experience adverse events. The risk may be even higher when turnover is high and when patients are children, as is often the case in ear, nose and throat surgery. This quality project therefore started in response to requests from physicians in two hospitals in the Flemish part of Belgium. The aim of this study is to use the Healthcare Failure Mode & Effect Analysis method to evaluate the process flow for ear, nose and throat patients, and to redesign the process to enhance patient safety., Methodology: In two One Day Clinics, processes were prospectively analysed using the Healthcare Failure Mode & Effect Analysis method., Results: Similar potential failures were reported in both hospitals. The major failure mode was linked to the absence of an active identity check throughout the process. The process was therefore redesigned by implementing a surgical safety checklist and an active identity check protocol. Although the Healthcare Failure Mode & Effect Analysis is a time-consuming method, this systematic approach by a multidisciplinary team has been found to be useful in detecting failure modes that need immediate safety responses. The involvement of all disciplines and an open safety culture during the procedure were the most important conditions., Conclusions: The Healthcare Failure Mode & Effect Analysis is a useful instrument for detecting the failure modes in this care process.

Objectives: Patient reported outcome measures (PROMs) asses the health status or health related quality of life from the patient's perspective. The aims of this study were to assess the effect of adenotonsillectomy on symptoms and daily functioning in children with sleep-disordered breathing (SDB) using an electronic questionnaire, and to determine if this is a feasible method to evaluate treatment outcome in this patient population., Methods: The electronic questionnaire was administered to the parents of children undergoing adenotonsillectomy for SDB on the day of surgery (T0), and two weeks (T1) and six months (T2) after surgery. The questionnaire scored symptoms in 5 different fields (snoring, sleepiness, behaviour, appetite, and apnoea). Higher scores indicated more pronounced symptoms. The score on T0 measured the preoperative symptoms. The main outcome measure (the change in scores between the postoperative measurements and the preoperative measurement) was analysed using the Wilcoxon signed-rank test., Results: Eighty-eight percent of invited patients participated in the study. Six percent had no access to internet, and another 6% did not wish to participate. Language problems were not reported. Response rates for T1 and T2 were 82.6% and 79.7% respectively. The T1 and T2 scores were significantly lower than the scores on T0 for snoring, behaviour, apnoea, and sleepiness. The T2 appetite score was significantly higher than on T0, which indicates an improvement of appetite., Conclusion: A comparison of pre- and postoperative results from an electronic disease-specific questionnaire indicated significantly improved symptoms and daily functioning in children undergoing adenotonsillectomy for SDB. High participation and response rates indicated it was feasible to assess treatment outcome by means of an electronic questionnaire.

Metastases to the oral cavity are rare and are most frequently seen in the jawbones. Soft tissue metastases as the first clinical sign of a metastatic cancer are quite exceptional. In this case report, we describe the history of a 67-year old patient presenting with painless oral lesions for 4 weeks. Biopsies showed metastases of an adenocarcinoma that was not yet identified. This case report highlights that an ENT physician should consider metastases to the oral cavity as part of the differential diagnosis in every patient with an uncommon, persistent oral lesion with unclear origin.

Arteries from young healthy animals respond to chronic changes in blood flow and blood pressure by structural remodeling. We tested whether the ability to respond to decreased (-90%) or increased (+100%) blood flow is impaired during the development of deoxycorticosterone acetate (DOCA)-salt hypertension in rats, a model for an upregulated endothelin-1 system. Mesenteric small arteries (MrA) were exposed to low blood flow (LF) or high blood flow (HF) for 4 or 7 weeks. The bioavailability of vasoactive peptides was modified by chronic treatment of the rats with the dual neutral endopeptidase (NEP)/endothelin-converting enzyme (ECE) inhibitor SOL1. After 3 or 6 weeks of hypertension, the MrA showed hypertrophic arterial remodeling (3 weeks: media cross-sectional area (mCSA): 10±1 × 10(3) to 17±2 × 10(3) μm(2); 6 weeks: 13±2 × 10(3) to 24±3 × 10(3) μm(2)). After 3, but not 6, weeks of hypertension, the arterial diameter was increased (Ø: 385±13 to 463±14 μm). SOL1 reduced hypertrophy after 3 weeks of hypertension (mCSA: 6 × 10(3)±1 × 10(3) μm(2)). The diameter of the HF arteries of normotensive rats increased (Ø: 463±22 μm) but no expansion occurred in the HF arteries of hypertensive rats (Ø: 471±16 μm). MrA from SOL1-treated hypertensive rats did show a significant diameter increase (Ø: 419±13 to 475±16 μm). Arteries exposed to LF showed inward remodeling in normotensive and hypertensive rats (mean Ø between 235 and 290 μm), and infiltration of monocyte/macrophages. SOL1 treatment did not affect the arterial diameter of LF arteries but reduced the infiltration of monocyte/macrophages. We show for the first time that flow-induced remodeling is impaired during the development of DOCA-salt hypertension and that this can be prevented by chronic NEP/ECE inhibition.

Background: Endothelin-1 (ET1) is a potent vasoconstrictor peptide with pro-mitogenic and pro-inflammatory properties and is therefore of interest in the development of endothelial dysfunction, endothelium-dependent flow-related remodeling, and hypertension-related remodeling. ET1 can be formed through cleavage of big ET1 by endothelin-converting enzyme (ECE) and neutral endopeptidase (NEP)., Method: We investigated whether the dual NEP/ECE inhibitor SOL1 improves resistance artery function and structure in 12 weeks old spontaneously hypertensive rats (SHRs) and whether arterial structural responses to decreased (-90%) or increased (+100%) blood flow are impaired in young SHRs. To this end two groups of SHRs received chronic 4-week treatment at two different time points (4-8 and 8-12 weeks) prior to the experiment. We compared in-vitro effects of cyclo-oxygenase inhibition (1 μmol/l indomethacine), nitric oxide synthase inhibition (100 μmol/l N(ω)-L-nitro arginine methyl ester), and stimulation of the endothelium by 0.001-10 μmol/l acetylcholine (ACh) in isolated third-order mesenteric arteries of SHRs and aged-matched Wistar-Kyoto (WKY) rats., Results: SOL1 had no effect on blood pressure in SHRs or WKY rats. ACh caused biphasic effects in mesenteric arteries of SHRs. The contractile component (endothelium-derived contractile factor) was absent in WKY and abolished by acute indomethacin administration or chronic SOL1 treatment. Endothelium-derived nitric oxide-type responses did not differ in both strains and were not influenced by SOL1 treatment. Endothelium-derived hyperpolarizing factor-type responses were severely impaired in SHRs as compared to WKY rats and were normalized by chronic SOL1 treatment. In first-order mesenteric arteries, outward flow-induced remodeling was impaired in SHRs. Chronic SOL1 treatment did not restore this response., Conclusion: Thus chronic SOL1 treatment during the development of hypertension in SHRs has no effect on blood pressure but improves several aspects of endothelium-dependent vasomotor responses but not arterial remodeling.

Objective: In Belgium, thyroidectomy is currently an inpatient procedure because of potential life-threatening post-operative complications that include hypocalcemia, laryngeal nerve damage and haemorrhage. Thyroidectomy can only be performed on an outpatient basis if the complication rate is low. The purpose of this study was to determine the feasibility and safety of outpatient hemithyroidectomy., Methodology: Between March 2008 and September 2010 we selected 54 patients who met our inclusion criteria for outpatient hemithyroidectomy. The procedure was carried out through a standard cervicotomy under general anaesthesia. No drains were used. We analysed patient outcome based on complications, unplanned admissions and readmissions., Results: The mean age of the 54 patients was 46 years, and most of them were women (81%). The mean duration of surgery was 64 minutes, and there were no intra-operative complications. After an observation period of at least 3 hours, 44 patients (81.5%) were discharged as planned. Ten patients (18.5%) required admission for urine retention (n = 1), social circumstances (n = 1), persistence of nausea (n = 3), delayed anaesthesia recovery (n = 4) and patient preference (n = 1). All 10 were discharged the next day, and none were readmitted., Conclusions: Our study shows that outpatient hemithyroidectomy performed by experienced surgeons in carefully selected patients can be safe and is associated with a low complication rate. However, this series is small and larger studies are needed to confirm the results.

Treatment for chronic inflammatory conditions in children should take into account the specific pathophysiological and clinical processes underlying these disorders. These guidelines provide a framework for both the medical and surgical treatment of chronic inflammatory diseases such as otitis media, allergic rhinitis and chronic rhinosinusitis, chronic inflammation of tonsils and adenoids, and laryngitis. In addition, the role of vaccinations and immunomodulatory therapies is discussed. Whenever possible, the evidence levels for specific treatments comply with the Oxford Levels of Evidence.

This paper reviews the contribution of the different parts of the oral cavity and the pharynx to the basic physiology of breathing, phonation, speech, swallowing, and of Waldeyer's ring to the functioning of the immune system. We discuss the development of taste and smell, as well as possibilities for chemosensory testing in children.

In children, all ENT cavities are particularly prone to the development of chronic inflammation. This is due to many predisposing factors, of which the most common are unfavourable anatomy, absence of nasal blowing, day care attendance, allergy, immature immunity, gastro-oesophageal reflux and tobacco smoke exposure. The aim of this paper is to outline the most specific paediatric clinical aspects of chronic pharyngo-tonsillitis, rhinosinusitis, otitis media, adenoiditis and laryngotracheitis and the important influence that some of these pathologies exert on the others.

The paracrine signaling peptide endothelin-1 (ET1) is involved in cardiovascular diseases, cancer and chronic pain. It acts on class A G-protein-coupled receptors (GPCRs) but displays atypical pharmacology. It binds tightly to ET receptor type A (ET(A)) and causes long-lasting effects. In resistance arteries, the long-lasting contractile effects can only be partly and reversibly relaxed by low-molecular-weight ET(A) antagonists (ERAs). However, the neuropeptide calcitonin-gene-related peptide selectively terminates binding of ET1 to ET(A). We propose that ET1 binds polyvalently to ET(A) and that ERAs and the physiological antagonist allosterically reduce ET(A) functions. Combining the two-state model and the two-domain model of GPCR function and considering receptor activation beyond agonist binding might lead to better anti-endothelinergic drugs. Future studies could lead to compounds that discriminate between ET(A)-mediated effects of the endogenous isopeptides ET1, ET2 and ET3 and that become more effective when the activity of the endogenous endothelin system is elevated., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The Alice in Wonderland syndrome is a rare clinical feature characterised by perceptual disturbances including visual disturbances and distortion of the body image. This uncommon--but often easy to recognise--syndrome, to which children seem particularly susceptible, can be defined in patients with Epstein Barr Virus (EBV) infection. This report describes a 10-year-old child with a mild upper airway obstruction and manifestations of the Alice in Wonderland syndrome resulting from an acute EBV infection. Because meningo-encephalitis was considered in the differential diagnosis, an MRI examination was performed under midazolam sedation, leading to a severe life-threatening upper airway obstruction.

Objectives: Tonsillectomies and adenotonsillectomies (TE and ATE) are among the most frequently performed operations in the western world. Despite the lack of generally accepted clinical guidelines about indications, the beneficial role of the procedure has been established. The aim of this study was to identify current practice relating to indications for tonsillectomies and adenotonsillectomies among Belgian ENT specialists., Methods: An anonymous questionnaire was sent to all Belgian ENT specialists. Part I of the questionnaire included questions about the ENT specialist himself/herself and his/her practice. Part II comprised questions about indications for TE/ATE in children up to 16 years of age. Part III included questions about indications in adults., Results: 238 out of 528 questionnaires were completed and returned. The majority of physicians consider TE/ATE to be indicated if a child or an adult suffers 3 or 4 tonsillitis episodes per year. The decision to operate on children for upper airway obstruction is mainly based on clinical and anamnestic findings. A peritonsillar abscess is usually considered to be an indication for surgery. We compared the results between different groups of ENT specialists and could detect differences in decision-making only according to the number of years of ENT practice. The stringency of surgeons' indications decreases with increasing surgeon age., Conclusions: The majority of respondents consider tonsillectomies/adenotonsillectomies to be indicated after 3 to 4 episodes of tonsillitis per year. In the case of upper airway obstruction in children, surgical indications are mainly based on clinical and anamnestic findings. Surgical decision-making appears to be influenced by the number of years of ENT practice.

Objective: A tonsillectomy, with or without an adenotomy ((A)TE), is a common surgical procedure in children. The most important indications are recurrent tonsillitis and upper airway obstruction secondary to adenotonsillar hypertrophy. The aim of this study was to investigate whether the current (A)TE practice in Belgium reduced the need for medical care., Study Design and Methods: The database of the Christelijke Mutualiteit, one of the most important health insurance organizations in Belgium, provided data on approximately 11,000 (A)TE's in children aged 0 to 15 years, performed by different ENT-specialists from Jan 1st 2002 to Sept 30th 2003. We compared the use of antibiotics during the 12 months before and the 12 months after (A)TE. We also compared the number of visits to pediatricians and general practitioners during the 12 months before and the 12 months after surgery., Results: The median antibiotic use dropped from 4 boxes in the year before the operation to 1 box in the year after the operation. The median number of doctor visits also dropped from 7 visits in the year before to 4 visits in the year after (A)TE., Conclusion: Although there are no generally accepted guidelines on the indications for (A)TE in Belgium, the current practice effectively reduced the need for medical care.

Objectives: There is still no consensus regarding the necessity of sending every tonsil specimen for histological examination following tonsillectomy. To add to this discussion, we assessed the incidence of preoperatively unexpected malignancy in the postoperative tonsil specimens of adults and children in our ENT department., Methods: We conducted a retrospective study of the histopathology results of all patients who underwent tonsillectomy between January 1999 and February 2006 in the ENT department of East Limburg Hospital in Genk. The charts of patients with postoperative histopathological malignancy were further analysed and reviewed for preoperative indications of the tonsillectomy and for preoperative suspicion of malignancy., Results: A total of 2989 patients were included in the study: 2058 children (defined as 16 years or younger) and 931 adults. No malignancy was found among the children. In 20 adults, malignancy was diagnosed, but in all cases there was a preoperative suspicion of malignancy. No patient without preoperative risk factors was found to have malignancy on pathological evaluation of the tonsils., Conclusion: Our results indicate that routine histopathological examination of tonsils removed for benign disease in adults and children is clinically unnecessary. We propose that on an individual basis, the surgeon should decide the need for histological examination depending on preoperative risk factors and peroperative gross examination. Such a strategy will only be medicolegally possible where there are national and scientifically (evidence)based ENT consensus reports or guidelines on this issue.

Unlabelled: PROBLEM/OBJECTIVES: To assess the safety of tonsillectomy as a one-day procedure, we retrospectively evaluated complications of tonsillectomy within two weeks after surgery., Methodology: The study included 1977 patients; 85% of the tonsillectomies were performed as a one-day procedure. Tonsillectomies were performed in Ziekenhuis Oost Limburg by one staff ENT and seven ENT residents between January 1, 1996 and January 1, 2005. We also reviewed the number of tonsillectomies performed as day surgery and their complication rate for Belgium, based on the National Office for Health and Disability Insurance billing, comparing our series with the number of tonsillectomies as day-case surgeries and their complication rate for Belgium., Results: In our study, 26 patients (1.3%) consulted within two weeks of surgery for major or minor complications secondary to tonsillectomy. The only major complication was primary bleeding (bleeding within 24 hours after tonsillectomy), which occurred in five patients, all of whom received a revision for haemostasis. No patient required transfusion. Minor complications (21 patients) were secondary bleeding, fever, and anorexia. During the study period, there were 214,524 tonsillectomies performed in Belgium. Based on invoice information, 4676 cases of postoperative bleeding occurred, requiring a revision for haemostasis. In our centre and generally for Belgium, there was an increase in tonsillectomies as an outpatient procedure without an increase in incidence of subsequent bleeding. Day-case surgery tonsillectomy incidence had risen from 36% in 1996 to 64% in 2004 in Belgium., Conclusion: Considering the low bleeding and complication rates, tonsillectomy can safely be performed as a day-case surgery.

Bilateral facial paralysis or paresis of peripheral origin is a rare condition and therefore represents a diagnostic challenge. We here present a case of a previously healthy woman who was hospitalized for symptoms of meningitis. On the second day of her hospital stay, she developed bilateral facial paresis. Later, the patient developed also tachycardia and dysrhythmias. A thorough diagnostic procedure including lumbar puncture, routine blood investigation with serological tests, MRI of the brain, Holter monitoring and transoesophageal echocardiographia, revealed meningitis with radiculitis, facial paresis and myocarditis. The clinical triad of meningitis, radiculitis and facial palsy is known as the Bannwarth Syndrome (Lyme disease). The patient was treated with ceftriaxone and recovered well. Despite repeatedly taken serological tests, Borrelia burgdorferi immunoglobulins were not detected. Acquired bilateral facial paralysis can occur in several diseases of infectious, neurological, idiopathic, iatrogenic, toxic, neoplastic or traumatic origin. In this article, we review the differential diagnoses and treatment options of bilateral facial paresis and present a scheme that is helpful in the diagnostic evaluation of this condition.

Septal suturing following nasal septoplasty, a valid alternative for nasal packing? After septal surgery most surgeons still routinely perform nasal packing since this is generally recommended. The aims of packing are numerous: haemostasis, prevention of haematoma, increase septal flap apposition, closure of dead space and prevention of displacement of the replaced cartilage. However, nasal packing is not an innocuous procedure and may lead to cardiovascular changes, continued bleeding, nasal injury, hypoxia, foreign body reaction or infection. The major disadvantage of nasal packing is patient discomfort--usually necessitating hospital stay--and the need to administer antibiotics. Therefore alternatives were sought. Sessions, Lee and Vukovic conceived and reported in the eighties forms of continuous septal suturing, but are not widely used. A similar technique of septal suturing after nasal septoplasty without nasal packing was used in 226 consecutive surgical procedures and reviewed retrospectively. Complications like postoperative episodes of bleeding, infections, septal haematomas, septal perforations or synechia were not noted. On one patient a recurrence of the septal deviation occurred. Patients reported almost no discomfort. Moreover, the septal surgery procedure could be carried out on a day-surgery basis. Readmission of a patient was never necessary. Based on these observations the septal suturing technique is a valid alternative to intranasal packing following septal surgery.