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Excess vitamin D and the ear

manipulating the catheter tip blindly through the nasopharyx into the oropharynx, despite gel lubrication, as this requires the tip to bend 90 inferiorly. Where the nasopharynx is completely filled with adenoid tissue, it may be impossible to pass the catheters or otherwise trauma may occur resulting in bleeding of the adenoids or posterior nasopharyngeal wall. Difficult catheter insertion can be facilitated by the simple manoeuvre of bending the catheter over double (Fig. 1) and inserting the U-shaped end created into the nose, parallel to the septum (Fig. 2). In all cases, this allows easy passage through the nasopharynx and into the oropharynx (Fig. 3), where the suction tipped end of the catheter can be retrieved through the mouth. This technique has resulted in successful catheter insertion without adenoid trauma in all 52 cases where it has been used by the authors.