Carcinoma of the middle ear is a difficult tumour to treat. We present ten cases and discuss stag... more Carcinoma of the middle ear is a difficult tumour to treat. We present ten cases and discuss staging of these tumours. Our results would suggest that a revised staging system may allow better identification of patients that would benefit from surgery whilst sparing some multilating surgery that offers little to improve their quality or quantity of life.
INTRODUCTION: The definition of severe recurrent throat infections is arbitrary, but recent crite... more INTRODUCTION: The definition of severe recurrent throat infections is arbitrary, but recent criteria have defined severe tonsillitis as: five or more episodes of true tonsillitis a year; symptoms for at least 1 year; and episodes that are disabling and prevent normal functioning. Diagnosis of acute tonsillitis is clinical, and it can be difficult to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis, but more accurate tests take longer to deliver results. Bacteria are cultured from few people with tonsillitis. Other causes include infectious mononucleosis from Epstein-Barr virus infection, cytomegalovirus, toxoplasmosis, HIV, hepatitis A, and rubella. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question:What are the effects of tonsillectomy in children and adults with acute recurrent or chronic throat infections? We searched: Medline, Embase, The...
An audiological investigation was performed of 20 patients suffering from the well characterized ... more An audiological investigation was performed of 20 patients suffering from the well characterized autoimmune disease systemic lupus erythematosus (SLE). In addition to threshold estimations, psychoacoustical tuning curves were measured to provide an indication of frequency-resolving ability. Comparison of these data with age, sex and socioeconomically matched controls did not show that the SLE group had significantly worse hearing.
Reactive arthritis following upper respiratory tract infections is well known. The usual age grou... more Reactive arthritis following upper respiratory tract infections is well known. The usual age group is young adults and management of the arthritis with anti-inflammatory medication is the mainstay of treatment. We present a case of reactive arthritis following tonsillitis, which was successfully treated by tonsillectomy.
Reactive arthritis following upper respiratory tract infections is well known. The usual age grou... more Reactive arthritis following upper respiratory tract infections is well known. The usual age group is young adults and management of the arthritis with anti-inflammatory medication is the mainstay of treatment. We present a case of reactive arthritis following tonsillitis, which was successfully treated by tonsillectomy.
ABSTRACT Objective: Assess a cohort of patients who underwent adenotonsillectomy for obstructive ... more ABSTRACT Objective: Assess a cohort of patients who underwent adenotonsillectomy for obstructive sleep apnea 4 years postsurgery for continued and long-term improvement in quality of life using the Child Health Questionnaire Physical Function version 28. We also sought to compare this group of children to a healthy United Kingdom population.
SummaryPseudodysphagia is the description of the sensation of a feeling of a lump in the throat—c... more SummaryPseudodysphagia is the description of the sensation of a feeling of a lump in the throat—commonly known as the globus symptom. A prospective analysis of 145 consecutive patients with this symptom seen by an Otolaryngologist has provided confirmation that a high proportion of these patients have a treatable basis for their complaints and that most can be successfully managed without time-consuming and expensive investigations—provided clinical evaluation includes thorough visualisation of the oropharynx and supraglottis. The explanation for the symptomatology in patients who suffer from reflux oesophagitis is probably referred pain from the region of the lower oesophageal sphincter rather than spasm of the upper sphincter. The expression globus hystericus is outdated and should be discarded, and we recommended describing the symptoms as primary globus pharyngeus when there is no evident cause and secondary globus pharyngeus when the aetiology is detectable.
To assess a cohort of patients who underwent adenotonsillectomy for obstructive sleep apnoea, 4 y... more To assess a cohort of patients who underwent adenotonsillectomy for obstructive sleep apnoea, 4 years after surgery for evidence of continued and long-term improvement in quality of life. We also sought to compare our results to Child Health Questionnaire scores obtained from our previous study. We also compared our data with a healthy UK children population from normative data available. Longitudinal study. University Hospital Tertiary Referral Centre. A 4-year follow-up study of 37 children who underwent adenotonsillectomy for obstructive sleep apnoea confirmed on polysomnography. There were 19 boys and 18 girls from our initial cohort. The primary caregiver completed the validated Child Health Questionnaire Parental Form version-28, 4 years after initial surgery. Our control group consist of 221 healthy children aged 6-18 that were included as 'normal' controls in a study looking at children with juvenile arthritis. The children were defined as healthy by a physician and/or after declaration by the parent. Child Health Questionnaire Parental Form version-28 scores. A total of 33 patients (89%) from our initial cohort were contacted. The mean age was 10.6 (median, 11; range, 5-16). When compared with results obtained 3 months postoperatively, the mean scores were higher in five domains and were statistically significant in three subscales (Role Limitations P < 0.00001; Bodily Pain P < 0.002; and Global Health P < 0.02). There was a significant deterioration in Behaviour subscale (P < 0.0007) in spite of surgery. Compared with controls, 4-year follow-up scores were higher in five domains with the Global Health domain (P < 0.0004) being statistically significant. When the 4-year follow-up scores were compared with preoperative values, these were higher in all 13 domains with statistically significant improvements in nine domains, indicating that improvements had persisted 4 years after surgery. At 4 years, however, the means scores in many domains remain lower when compared with controls. Quality-of-life data are an important measure when deciding on a specific clinical intervention. In the short term, quality-of-life measures have been shown to improve after adenotonsillectomy for obstructive sleep apnoea. Our study demonstrates that the benefits of surgery are still persistent and the children continue to improve in the long term.
Carcinoma of the middle ear is a difficult tumour to treat. We present ten cases and discuss stag... more Carcinoma of the middle ear is a difficult tumour to treat. We present ten cases and discuss staging of these tumours. Our results would suggest that a revised staging system may allow better identification of patients that would benefit from surgery whilst sparing some multilating surgery that offers little to improve their quality or quantity of life.
INTRODUCTION: The definition of severe recurrent throat infections is arbitrary, but recent crite... more INTRODUCTION: The definition of severe recurrent throat infections is arbitrary, but recent criteria have defined severe tonsillitis as: five or more episodes of true tonsillitis a year; symptoms for at least 1 year; and episodes that are disabling and prevent normal functioning. Diagnosis of acute tonsillitis is clinical, and it can be difficult to distinguish viral from bacterial infections. Rapid antigen testing has a very low sensitivity in the diagnosis of bacterial tonsillitis, but more accurate tests take longer to deliver results. Bacteria are cultured from few people with tonsillitis. Other causes include infectious mononucleosis from Epstein-Barr virus infection, cytomegalovirus, toxoplasmosis, HIV, hepatitis A, and rubella. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question:What are the effects of tonsillectomy in children and adults with acute recurrent or chronic throat infections? We searched: Medline, Embase, The...
An audiological investigation was performed of 20 patients suffering from the well characterized ... more An audiological investigation was performed of 20 patients suffering from the well characterized autoimmune disease systemic lupus erythematosus (SLE). In addition to threshold estimations, psychoacoustical tuning curves were measured to provide an indication of frequency-resolving ability. Comparison of these data with age, sex and socioeconomically matched controls did not show that the SLE group had significantly worse hearing.
Reactive arthritis following upper respiratory tract infections is well known. The usual age grou... more Reactive arthritis following upper respiratory tract infections is well known. The usual age group is young adults and management of the arthritis with anti-inflammatory medication is the mainstay of treatment. We present a case of reactive arthritis following tonsillitis, which was successfully treated by tonsillectomy.
Reactive arthritis following upper respiratory tract infections is well known. The usual age grou... more Reactive arthritis following upper respiratory tract infections is well known. The usual age group is young adults and management of the arthritis with anti-inflammatory medication is the mainstay of treatment. We present a case of reactive arthritis following tonsillitis, which was successfully treated by tonsillectomy.
ABSTRACT Objective: Assess a cohort of patients who underwent adenotonsillectomy for obstructive ... more ABSTRACT Objective: Assess a cohort of patients who underwent adenotonsillectomy for obstructive sleep apnea 4 years postsurgery for continued and long-term improvement in quality of life using the Child Health Questionnaire Physical Function version 28. We also sought to compare this group of children to a healthy United Kingdom population.
SummaryPseudodysphagia is the description of the sensation of a feeling of a lump in the throat—c... more SummaryPseudodysphagia is the description of the sensation of a feeling of a lump in the throat—commonly known as the globus symptom. A prospective analysis of 145 consecutive patients with this symptom seen by an Otolaryngologist has provided confirmation that a high proportion of these patients have a treatable basis for their complaints and that most can be successfully managed without time-consuming and expensive investigations—provided clinical evaluation includes thorough visualisation of the oropharynx and supraglottis. The explanation for the symptomatology in patients who suffer from reflux oesophagitis is probably referred pain from the region of the lower oesophageal sphincter rather than spasm of the upper sphincter. The expression globus hystericus is outdated and should be discarded, and we recommended describing the symptoms as primary globus pharyngeus when there is no evident cause and secondary globus pharyngeus when the aetiology is detectable.
To assess a cohort of patients who underwent adenotonsillectomy for obstructive sleep apnoea, 4 y... more To assess a cohort of patients who underwent adenotonsillectomy for obstructive sleep apnoea, 4 years after surgery for evidence of continued and long-term improvement in quality of life. We also sought to compare our results to Child Health Questionnaire scores obtained from our previous study. We also compared our data with a healthy UK children population from normative data available. Longitudinal study. University Hospital Tertiary Referral Centre. A 4-year follow-up study of 37 children who underwent adenotonsillectomy for obstructive sleep apnoea confirmed on polysomnography. There were 19 boys and 18 girls from our initial cohort. The primary caregiver completed the validated Child Health Questionnaire Parental Form version-28, 4 years after initial surgery. Our control group consist of 221 healthy children aged 6-18 that were included as 'normal' controls in a study looking at children with juvenile arthritis. The children were defined as healthy by a physician and/or after declaration by the parent. Child Health Questionnaire Parental Form version-28 scores. A total of 33 patients (89%) from our initial cohort were contacted. The mean age was 10.6 (median, 11; range, 5-16). When compared with results obtained 3 months postoperatively, the mean scores were higher in five domains and were statistically significant in three subscales (Role Limitations P < 0.00001; Bodily Pain P < 0.002; and Global Health P < 0.02). There was a significant deterioration in Behaviour subscale (P < 0.0007) in spite of surgery. Compared with controls, 4-year follow-up scores were higher in five domains with the Global Health domain (P < 0.0004) being statistically significant. When the 4-year follow-up scores were compared with preoperative values, these were higher in all 13 domains with statistically significant improvements in nine domains, indicating that improvements had persisted 4 years after surgery. At 4 years, however, the means scores in many domains remain lower when compared with controls. Quality-of-life data are an important measure when deciding on a specific clinical intervention. In the short term, quality-of-life measures have been shown to improve after adenotonsillectomy for obstructive sleep apnoea. Our study demonstrates that the benefits of surgery are still persistent and the children continue to improve in the long term.
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Papers by Antony Narula