The problem of the arytenoid (vocal process) granuloma has taxed laryngologists for generations, with a paper from St Clair Thomson appearing in The Journal over a century ago Reference Thomson7 and Pat Bradley from Nottingham reviewing the history of the topic in 1997. The authors find that some of the current guidelines are disappointing, failing to achieve what could be expected or hoped for from such guidelines, but the American Academy of Otolaryngology – Head and Neck Surgery guidelines perform better in meeting their criteria in the various domains. ![]() This issue has a paper from several centres in the USA, which assesses clinical practice guidelines for BPPV, Reference Pandya, Suresh, Shah, Romeo, Ravin and Barrette6 and emphasises the potential for such guidelines in improving speed of diagnosis and evidence-based treatment outcomes for this common condition. Reference Ullas, McClelland and Jones3īenign paroxysmal positional vertigo (BPPV) and its clinical subtypes have been a regular feature of The Journal, Reference Ichijo4 and comprise a significant proportion of the clinical caseload in balance clinics, Reference Kim, Jeong and Shin5 with the condition often initially misdiagnosed. This was reviewed very well by the Nottingham team back in 2013, which covered the specialty-wide topic of ‘medically unexplained symptoms’. The interface between psychiatry and tinnitus patients was considered in an article published in The Journal of Laryngology & Otology some years ago, Reference Pinto, Marcelos, Mezzasalma, Osterne, de Melo Tavares de Lima and Nardi2 and the insights in this month's paper has relevance to other functional symptoms in ENT, as may be seen also in the rhinology and laryngology clinic. Reassuring a patient with the message that ‘the tests are normal with no need to worry’ is inadequate on its own, and this paper can help us offer the patient more. ![]() This issue's paper of the month, Reference Scholfield, Chandrasekharan, Bahra, Williams and Patel1 by a team from Whipps Cross (London) and Anglia Ruskin (Cambridge), considers the matter in some detail, proposing a helpful model to assist the clinician in assessing this tricky group of patients. ![]() Assessment can be far from straightforward. The otology clinic contains patients whose symptoms may not be explained by standard inflammatory or mechanical pathologies, and the term ‘functional’ brings us into the interface between neurology, psychology, psychiatry and ENT.
0 Comments
Leave a Reply. |