Includes bibliographical references. / Sinonasal tumours have been resected endoscopically at Groote Schuur Hospital Cape Town South Africa since 2003. Surgery, although seen as minimally invasive because no external incisions are visible, is often very aggressive and destructive to the nasal structures. The removal of the nasal turbinates has always been seen as sacrilege due to the risk of developing atrophic rhinitis. If the theory regarding developing atrophic rhinitis after a simple turbinectomy stands true, one would expect a high incidence of atrophic rhinitis after radical resection of the sinonasal structures. This has not been our experience. METHODS: The study population includes a retrospective case review of all patients that had endoscopic sinonasal tumour resection by the same surgeon between 2006 and 2010. All patients were assessed for symptoms and signs suggestive of atrophic rhinitis up to two years post resection. RESULTS: 51 patients (34M: 17F) were included in the study. Patients with residual or recurrent tumour (n=19) and patients who had received adjuvant radiotherapy (n=17) had a statistically significant chance of developing symptoms and signs suggestive of atrophic rhinitis over time. Variables such as age, gender, extent of surgery, bilateral disease, benign or malignant tumour, were not statistically significant in the development of symptoms and signs suggestive of atrophic rhinitis over time. CONCLUSIONS: Atrophic rhinitis is not more common in patients who undergo endoscopic sinonasal surgery without adjuvant therapy. However, patients with residual tumour (after debulking surgery) or recurrent tumour and those who had received adjuvant radiotherapy had a statistically significant chance of developing symptoms and signs suggestive of atrophic rhinitis over time. Keywords: atrophic rhinitis, endoscopic resection, turbinectomy, medial maxillectomy, sinonasal tumours.

Surgical approaches for many tumours are often limited by blood loss, exposure and risk to vital anatomical structures; therefore, the standard of care for certain skull base tumours has become endoscopic transnasal resection. Other surgical disciplines often use cell salvage techniques, but review of the otolaryngology literature reveals very few case reports. General surgery procedures are often carried out in a contaminated field and concerns have been raised about its safety. This study investigates the value and safety of salvage-type autologous blood transfusion during the endoscopic resection of juvenile nasopharyngeal angiofibromas (JNA). Methods: Because JNA is a rare vascular nasal tumour, the study extended over a 3-year period to obtain adequate patient numbers. All patients undergoing endoscopic resection during this period were included in the population sample. Ten patients with JNA were identified and underwent embolization prior to endoscopic resection. In all cases the intraoperative blood salvage apparatus was used. Close post-operative monitoring was performed.

Statement of problem: Topical corticosteroids nasal sprays remain first line of treatment for patients with chronic rhinosinusitis (with or without nasal polyps). The main aim of treatment is to improve nasal symptoms by reducing or eliminating the nasal polyps and preventing polyp recurrence post-operatively. Our aims were to determine if the type of corticosteroid nasal spray used post operatively influences polyp recurrence rate and if there were any subsequent economic implications as we only have beclomethasone available for prescription in our state hospital. Methods: Retrospective case note review of all Samter's patients who underwent fronto-spheno-ethmoidectomy by a single surgeon (2000 – 2014). Results: 58 patients were included in our study, divided into 3 study groups. When compared to patients using beclomethasone; patients using fluticasone had an 80% reduced risk of polyp recurrence and patients using mometasone a 90% reduced risk. This rose to 88% and 96% respectively when adjusted for age. Conclusion: Fluticasone and mometasone are both statistically significantly more effective at reducing polyp recurrence than beclomethasone in our population group. Mometasone appeared more effective than fluticasone, but this difference was not statistically significant.

Background: Sino-Nasal Melanomas (SNM) are rare, aggressive tumours often associated with a poor prognosis due to advanced stage disease at presentation. Mean 5-year survival is 0-46%. Various treatment modalities are used in the management of SNM. Surgery is regarded as the primary treatment modality, but therapy remains controversial. Complete resection is a surgical challenge and it is often impossible to achieve adequate margins due to the fact that tumour often abuts vital anatomical structures. Incomplete resection has been shown to be a predictor of poor survival. Harris et al. (2014) were the first to report on the use of post-operative brachytherapy in an attempt to prevent local recurrence after endoscopic resection of SNM. Methods: A retrospective analysis of all patients undergoing endoscopic resection of SNMs and receiving adjuvant brachytherapy in a single surgeon’s practice between August 2004 and May 2014 was carried out. Outcome measures included local control rate and 5-year overall survival estimated by Kaplan-Meier analysis. The incidence of regional and distal recurrence (metastases) was calculated Results: Five cases of sinonasal melanoma (3 males 2, females) were managed with endoscopic resection and adjuvant brachytherapy. Patients were followed up for a median duration of 61 months (32-154 months) following adjuvant Brachytherapy. Local control was achieved in four out of five patients (80%). Three out of five patients developed distant metastasis. Median time to metastasis was 54 months. One patient received immunotherapy after diagnosis of distant metastasis (BRAF positive). Three out of five patients (60%) died from the complications of distant metastases of sinonasal melanoma. Median survival time following adjuvant Brachytherapy was 61 months (32-154 months). Five-year survival rate was 40% (95% CI 5.2% - 75.3%). Conclusion: This is the only case series describing the use of brachytherapy following endoscopic resection of sinonasal melanoma. Our case series, albeit small, describes a local control rate and 5-year survival comparable with the best reported in the literature. Adjuvant brachytherapy represents a novel approach and potentially a useful addition to the adjuvant therapy armamentarium. The advantages of brachytherapy include a favourable side-effect profile and a shorter duration of treatment, while delivering a dose of radiation similar to that of Conventional Radiotherapy. Further studies are necessary to define the role of brachytherapy in sinonasal melanoma.

Background. Adeno-/tonsillectomy is a commonly performed procedure with internationally standardised and recognised indications. Despite this, there exists considerable international (190 - 850/100 000 people ≤19 years of age) and regional variation in adeno-/tonsillectomy rates. This variation has been ascribed to differences in clinical practice and referral patterns, as well as social and family factors, rather than differences in clinical need or regional morbidity. Objectives. To describe the adeno-/tonsillectomy rate in the South African private healthcare sector, and regional variations thereof. To compare local rates with international rates and to assess current trends in adeno-/tonsillectomy clinical practice. Methods. Analysis of adeno-/tonsillectomy data from January 2012 to December 2013, provided by the largest South African private healthcare funder, accounting for 31% of the medical scheme market. Rates are expressed per 100 000 people ≤19 years of age. Results. The tonsillectomy rate in the South African private healthcare sector was 1888/100 000 people ≤19 years of age in 2012. In 2013, the rate dropped significantly (p-value <0.001) to 1755/100 000. Both are more than double the highest national tonsillectomy rate reported in the literature. There was also considerable regional variation in the adeno-/tonsillectomy rate within South Africa. Otorhinolaryngologists are responsible for approximately 80% of adeno- /tonsillectomies performed in the South African private healthcare sector. Discussion. The South African tonsillectomy rate is very high when compared to international trends and varies regionally within the country. The literature does not support an increased burden of disease as the reason behind this. Rather, it is differences in training and clinical practice of clinicians, as well as social and family factors that have been implicated. Conclusion. The adeno-/tonsillectomy rate in the South African private healthcare sector is substantially higher than international norms. The reasons for this discrepancy require further consideration and investigation.

Introduction: HIV-positive children are possibly more prone to developing cholesteatoma. Chronic inflammation of the middle ear cleft may be more common in patients with HIV and this may predispose HIV-positive children to developing cholesteatoma. There are no studies that describe the radiological morphology of the middle ear cleft in HIV-positive compared to HIV-negative children with cholesteatoma. Aim: Compare the radiological differences of the middle ear cleft in HIV-positive and HIV-negative children with cholesteatoma. Method A retrospective, cross-sectional, observational analytical review of patients with cholesteatoma at Red Cross War Memorial Children's Hospital over a 6 year period. Results: Forty patients were included in the study, 11 of whom had bilateral cholesteatoma and therefore 51 ears were eligible for our evaluation. HIV-positive patients had smaller (p=0.02) mastoid air cell systems (MACS). Forty percent of HIV-positive patients had sclerotic mastoids, whereas the rate was 3% in HIV-negative ears (p<0.02). Eighty-two percent of the HIV-positive patients had bilateral cholesteatoma compared to 7% of the control group (p<0.02). There was no difference between the 2 groups with regards to aeration of the middle ear cleft, bony erosion of middle ear structures, Eustachian tube obstruction or soft tissue occlusion of the post-nasal space. Conclusion: HIV-positive paediatric patients with cholesteatoma are more likely to have smaller, sclerotic mastoids compared to HIV-negative patients. They are significantly more likely to have bilateral cholesteatoma. This may have implications in terms of surveillance of HIV-positive children, as well as, an approach to management, recurrence and follow-up. HIV infection should be flagged as a risk factor for developing cholesteatoma.

Includes bibliographical references (leaves 33-34). / The objectives of the study were to determine the accuracy of Sentinel Lymph Node Biopsy (SLNB) in head and neck squamous cell carcinoma (SCC); to determine its role in the approach to the clinically N+ neck in a Developing World setting; and its accuracy as an indicator of regional lymph node status in the clinically N neck.

Aims of the study: To document the incidence and severity of aminoglycoside-induced ototoxicity at Brooklyn Chest Hospital; To determine the prevalence of the 6 known aminoglycoside-induced deafness mutations in the MT-RNR1 gene (A1555G, C1494T, T1095C, T1291C, A827G and 961 indel C) in a cohort of MDR-TB patients; To determine whether HIV positive MDR-TB patients are more likely to develop aminoglycoside-induced hearing loss than HIV negative MDR-TB patients; To provide clinical guidelines to the medical fraternity on the use of aminoglycoside antibiotics with regard to the side-effect of ototoxicity.

Includes bibliographical references. / Patients that have undergone a laryngectomy lose the normal heat-moisture-exchange functions of the nose and upper airways. Breathing unconditioned air can cause irritation of the tracheal and bronchial mucosa and lead to chest complaints such as irritating coughing and excessive mucus production and mucus plugs. Disposable HME's that cover the tracheostoma and are stuck to the skin with adhesives are believed to improve the condition of inspired air for laryngectomy patients. HME's work by accumulating heat and moisture during exhalation and reciprocally warming and humidifying in spired air. Due to the cost of HMEs they are not affordable to the general population in South Africa and many other countries. Stoma Covers are simple devices made of a single fabric or combinations of fabrics that are fastened around the neck with the cloth covering the tracheostoma. They are relatively inexpensive to manufacture and can be washed and re-used. No research has been conducted to date regarding the effect of using simple Stoma Covers to improve the tracheal climate in laryngectomy patients.

Background: Hearing loss is a global health burden affecting 360 million people. The highest prevalence is in the Developing World where hearing screening programmes are scarce, and failure to address growing high-risk populations will result in new deaf communities. In resource stretched communities such as these, new strategies to alleviate this burden are necessary. Advances in technology have led to innovative mobile digital devices like smartphones and tablets with the potential to test hearing through audiometric applications. Given the recent upsurge of mobile technology in Africa, it is befitting to determine whether the implementation of science can translate to health service delivery. Objectives: To validate the Apple iPhone mobile device using the uHearâ„¢ application "app" as a possible hearing screening tool in the Developing World.