Malignant external otitis: The shifting treatment paradigm

Importance

Malignant external otitis (MEO) is an aggressive infection occurring in immunocompromised hosts. Increasing antimicrobial resistance is making the disease more difficult to treat.

Endoscopic electrosurgical management of posterior epistaxis: shifting paradigm

Recent literature has embraced the use of electrosurgery, sphenopalatine vascular clipping, and endoscopy in posterior epistaxis. With the advent of endoscopy, the surgical treatment of posterior epistaxis has shifted from internal maxillary ligation to endoscopic sphenopalatine artery control. This article introduces an endoscopic electrosurgical approach for patients suffering from idiopathic posterior epistaxis that combines one or more of the following methods: endoscopic selective branch cauterization, endoscopic sphenopalatine artery cautery, and endoscopic posterior nasal cauterization. This approach is currently used in a hospital-based community otolaryngology practice and is presented from a Canadian health care perspective (Quebec). This article presents the experience in a series of 17 patients treated during a 35-month period and prospectively followed and discusses the surgical technique, patients' outcome, and the implications of such a practice.     

Expressive language development of children exposed to cocaine prenatally: literature review and report of a prospective cohort study

It was hypothesized that prenatal exposure to cocaine and other substances would be related to delayed expressive language development. Speech and language data were available for 458 6-year olds (204 were exposed to cocaine). No significant univariate or multivariate differences by cocaine exposure group were observed. Classification and regression tree modeling was then used to identify language variable composites predictive of cocaine exposure status. Meaningful cut points for two language measures were identified and validated. Children with a type token ratio of less than 0.42 and with fewer than 97 word types were classified into a low language group. Low language children (n = 57) were more likely to be cocaine exposed (63.1%), with cocaine-exposed children 2.4 times more likely to be in the low language group compared with control children after adjustment for covariates. Prenatal cigarette, but not alcohol exposure, was also significantly related to expressive language delays.     

Effects of cocaine on human nasal mucosa

Summary The effects of cocaine on the contractile response of isolated human nasal mucosal blood vessels to field stimulation and methoxamine were investigated. Results showed that cocaine antagonized methoxamine and inhibited field stimulation. The drug increased resting tension in human nasal mucosa in vitro through direct actions and potentiated mucosal contractions by norepinephrine and epinephrine. The study indicated that high concentrations of cocaine may actually antagonize -adrenoceptors, but these concentrations are not necessary in eliciting desired degrees of vasoconstriction in nasal blood vessels while being applied as a local anesthetic.     

Considerations on the physiopathological mechanism of inner ear damage induced by intravenous cocaine abuse: cues from a case report

Objective

Aim of the following paper is to discuss about the possible etiopathogenetic mechanisms of inner ear damage induced by cocaine abuse. Unfortunately the data concerning this topic are very limited; the authors are then presenting a literature review, also discussing the clinical presentation and the possible therapeutical approach of a clinical case of bilateral sudden sensorineural hearing loss following i.v. injection of cocaine.

Patients

Case report.

Intervention

A strictly audiological evaluation has been performed, in order to identify the cochlear lesion site(s) and to provide the best medical treatment.

Conclusions

To our knowledge, this is the first report of acute cocaine intoxication with sudden bilateral hearing loss. Further studies are required in order to understand the effects of these substances on the inner ear cells and metabolism.     

Sudden bilateral sensorineural hearing loss after intravenous cocaine injection: A case report and review of the literature

Little is known about the effects of intravenous abuse of cocaine, especially on the inner ear. We report on a 26‐year‐old man who presented to our outpatient department with a sudden severe hearing loss after intravenous injection of cocaine. The audiogram on admission showed symmetric air conduction levels up to 80 dB at 4 kHz. After treatment with intravenous sodium chloride, prednisolone, and pentoxifylline, the audiogram 2 days later showed a bilateral normacusis. A review of the literature on the topic is given and possible reasons for inner ear damages caused by cocaine are discussed. Laryngoscope, 2009     

The clinical use of cocaine in rhinosurgery: a case-report and a review

Three patients with adverse reactions of the nasal mucosa after topical anaesthesia with crystalline cocaine in combination with adrenaline are described. The current knowledge of the pharmacology of cocaine is summarized. The systemic and local reactions and side-effects of cocaine as topical anaesthetic in rhinosurgery are reviewed.     

Changes in hearing aid use over the past 20 years

The aim of this study was to find out how the use of hearing aids has been affected by the changes in hearing rehabilitation, hearing aids and society over the past 20 years. Seventy-six first-time hearing aid users were interviewed at their homes, and the results were compared with those of an earlier study made with the same method in 1983 in Finland involving both new and experienced hearing aid users. Hearing aid use and handling skills as well as satisfaction with the hearing aid were explored with interviews using the same questions in both studies. The number of first-time hearing aid users who did not use their hearing aids had decreased from 33.3% in 1983 to 5.3% at the present. Conversely, the number of regular users rose from 40.9 to 56.6%. The use of hearing aids was increased. The users were better able use their hearing aids and were more satisfied with them and the number of those who considered the counseling provided sufficient had also increased.     

Relapsing polychondritis: a course over 20 years with cerebral involvement

Relapsing polychondritis is a chronic inflammatory disease associated with an autoimmune disorder in cartilaginous tissue, eyes, labyrinth, blood vessels, and central nervous system. We describe a 75-year-old woman who presented with a 20-year history of dyspnea, inspiratory stridor, and polyarthritis. She developed dysmorphism of both ears and a saddle nose approximately 10 years earlier. Subsequently, she suffered from hearing loss and a tremor. A T2-weighted magnetic resonance imaging scan of the brain revealed multiple, spotted signal intensities. Immunohistochemical analysis of a serum sample showed antibodies to cartilaginous tissue, which were further identified on immunoblotting as antibodies to type II collagen. The extremely prolonged course of disease (>20 years) until a correct diagnosis was made is remarkable. Also, cerebral involvement, which was most likely caused by cerebral angiitis, and which, to our knowledge, has never previously been reported in this form, was detected. Arch Otolaryngol Head Neck Surg. 2000;126:1495-1498     

Vocal fold immobility: a longitudinal analysis of etiology over 20 years

OBJECTIVES: To determine the current etiology of vocal fold immobility, identify changing trends over the last 20 years, and compare results to historical reports. STUDY DESIGN: The present study is a retrospective analysis of all patients seen within a tertiary care institution between 1996 and 2005 with vocal fold immobility. The results were combined with a previous study of patients within the same institution from 1985 through 1995. Results were compared to the literature. METHODS: The medical records of all patients assigned a primary or additional diagnostic code for vocal cord paralysis were obtained from the electronic database. RESULTS: Eight hundred twenty-seven patients were available for analysis (435 from the most recent cohort), which is substantially larger than any reported series to date. Vocal fold immobility was most commonly associated with a surgical procedure (37%). Nonthyroid surgeries (66%), such as anterior cervical approaches to the spine and carotid endarterectomies, have surpassed thyroid surgery (33%) as the most common iatrogenic causes. These data represent a change from historical figures in which extralaryngeal malignancies were considered the major cause of unilateral immobility. Thyroidectomy continues to cause the majority (80%) of iatrogenic bilateral vocal fold immobility and 30% of all bilateral immobility. CONCLUSIONS: This 20-year longitudinal assessment revealed that the etiology of unilateral vocal fold immobility has changed such that there has been a shift from extralaryngeal malignancies to nonthyroid surgical procedures as the major cause. Thyroid surgery remains the most common cause of bilateral vocal fold immobility.     

Nasal cocaine abuse presenting as a central facial destructive granuloma

We describe a 36-year-old patient with an aggressive, midline intranasal and naso-and oropharyngeal destructive process. For months the patient denied heavy abuse of nasal cocaine, but finally admitted it. Necrosis and atrophy of the inferior and middle nasal turbinates bilaterally, prominent naso and oropharyngeal ulcers, nasal septal as well as hard palate perforation were observed clinically. Repeated biopsies revealed focal areas of chronic inflammation and necrosis, but there was no evidence of vasculitis or granuloma formation. Since serum was slightly positive for antineutrophil cytoplasmic antibody, the initial diagnosis was Wegener’s granulomatosis. In the United States there have been a few reports on a new cocaine-associated syndrome presenting as an aggressive, midline, intranasal and intrapharyngeal destructive process mimicking limited Wegener’s granulomatosis and midline reticulosis. We report the first such case in Europe and offer guidelines for the diagnostic work-up of such cases. Received: 6 May 1998 / Accepted: 14 May 1998     

Congenital nasal pyriform aperture stenosis: Elaboration of a management algorithm from 25 years of experience

IntroductionCongenital nasal pyriform aperture stenosis (CNPAS) is a rare disease presenting with neonatal respiratory distress, often associated with other anomalies.Materials and methodsThis study reports the clinical and radiological characteristics of the patients managed in The Department of Pediatric Otolaryngology Head and Neck Surgery of La Timone Children's Hospital in Marseille between 1988 and 2014. Pyriform aperture (PA) widths were measured on CT-scans, obtained by using hand calipers at the largest portion of the PA in a plan parallel to the Francfort plan.Results10 patients were included. Average PA width was 6.6 mm, 5/10 patients presented with single central maxillary median incisor, 6/10 patients had associated abnormalities. 8 patients underwent a surgical intervention and 2 patients were medically managed. All the patients had satisfactory nasal airway permeability on late follow-up.A management algorithm was elaborated. CNPAS should be evoked when breathing difficulties are associated with impossibility of passing fiberscope or nasogastric tube at the nasal inlet. Craniofacial CT-scanning is necessary to make the diagnosis and look for associated abnormalities. Medical treatment associating nasal wash and decongestants should be performed. Surgical intervention is necessary when failure of the medical management.Discussion and conclusionsOur results were close to those found in the literature in terms of clinical characteristics, associated abnormalities and PA width. However, no objective criterion to decide whether a surgical intervention is necessary or not, has been established so far. The algorithm we propose offers guidelines from diagnosis to treatment, but the management should be adapted based on clinical tolerance.     

Adenoidectomy for middle ear effusion: a study of 50,000 children over 24 years

OBJECTIVE: To compare the incidence and outcomes of myringotomy plus ventilation tube insertion (MVTI) alone and that concurrent with pharyngeal surgery (adenoidectomy, adenotonsillectomy, or tonsillectomy) at a population level. STUDY DESIGN: Observational, retrospective, population-based study using hospital administrative data. METHODS: All hospital morbidity information was obtained for children who underwent a first MVTI procedure while less than 10 years of age in any Western Australian hospital from 1981 to 2004. Further MVTI procedures and additional pharyngeal surgery were subsequently identified for each child. RESULTS: There were 51,373 children less than 10 years of age who underwent at least one MVTI procedure from 1981 to 2004. Twenty-nine percent underwent pharyngeal surgery at the time of first MVTI procedure, and of these, 7.4% (1,096) had pharyngeal surgery in the absence of adenoid or tonsil disease. Adenoid surgery at time of MVTI was associated with reduced odds of subsequent MVTI procedures in children with or without adenoid/tonsil disease. In more recent calendar periods, no differences in the length of hospital stay between MVTI alone and with adenoidectomy was observed, whereas procedures involving tonsils required an additional bed day per procedure and were associated with more episodes of operative and postoperative hemorrhage. CONCLUSION: Having adenoidectomy or adenotonsillectomy surgery at time of first or subsequent MVTI was associated with reduced risk of further MVTI surgery. The low complication rates for adenoidectomy and short hospital stays make adjunctive adenoidectomy a potentially cost-effective first line management option for otitis media with effusion.     

Epistaxis and hospitalization: a retrospective observational study over 4 years of 260 patients

OBJECTIVE: Epistaxis is a frequent emergency for which guidelines and treatment are well known. Nevertheless few studies have evaluated the factors that may influence the decision for hospitalisation. Through a retrospective study we have searched to define potential factors which lead to taking such a decision. METHODS: Retrospective analysis of charts of 260 patients hospitalized for epistaxis. For each patient we have reviewed several data including, age, associated pathologies, current treatment, duration of the stay, complications, recurrences etc... RESULTS: If the severity of the bleeding is one of the major factor, socio-economic factors are also taken into account and may influence the decision to hospitalize. Age, associated pathologies (hypertension, hemopathy) and their treatment (anti-coagulant) also play a role in this decision. Furthermore an obvious strategy in the choice of the different treatment may help to reduce the length of stay and the morbidity of each treatment. CONCLUSION: We propose some modifications to our strategy to improve the management of epistaxis. This includes the use of endoscopic techniques for diagnosis and treatment.     

Suppression and recovery of voltage-gated currents after cocaine treatments of olfactory receptor cells

Objective

Cocaine (1–5% concentrations) is commonly used as a local anesthetic for the otorhinolaryngeal surgery of the nasal cavity. Recent reports indicate that some patients complain of olfactory deficits after surgery, and decreased olfaction is found in cocaine abusers. In spite of these reports, the effects of cocaine on the olfactory receptor cells are unknown.

Methods

Effect of cocaine was examined in olfactory receptor cells isolated from the newt. Under the voltage clamp with the whole-cell recording configuration, the voltage-gated currents were recorded when the membrane potential was depolarized from a holding potential of −100 mV in a step wise between −90 mV and +40 mV.

Results

When cocaine was applied by a puff pressure (5%) and the extracellular solution, the voltage-gated currents, including inward and outward components, were significantly reduced. The dose–suppression curves of cocaine for sodium and potassium currents could be fitted by the Hill equation. Half-blocking concentration of sodium and potassium currents were 43 μM and 557 μM; Hill coefficient was 1.1 and 0.9, respectively.

Conclusion

This rapid and complete recovery from the suppression was confirmed even after the treatments with the high concentration cocaine. This fact implies that cocaine does not affect olfactory ability after locally high dose treatments of nasal cavity in surgical operation.     

Acute mastoiditis in children, a retrospective analysis about a period of 25 years

BACKGROUND: During the last years the classical signs of the acute mastoiditis have changed. Aim of the following study was to examine the change of symptoms as well as the change of incidence. METHODS/PATIENTS: The records of 113 children who received mastoid surgery due to acute mastoiditis were retrospectively investigated. Data covered a regional group of patients during a period of 25 years (1979 - 2003). RESULTS: Considering the drop of the birthrate from 1991 in the East German countries, there was a significant increase of the incidence of acute mastoiditis. The patients had a mean age of 2,5 years. The classical symptoms like "retroauricular swelling, tenderness and protrusion of the auricle" were only noted by 47 children (41.6 %). Preoperative complications appeared as facial palsy, abscess and septic lateral sinus thrombosis in 11 children. Bacterial cultures, taken during surgery yielded in 55.7 % Streptococcus pneumoniae. The therapy contained a surgical intervention combined with antibiotics. CONCLUSIONS: An early surgical treatment by mastoidectomy or antrotomy supported by antibiotics represents the safest method to avoid complications.     

Complementary and alternative medicine use by otolaryngology patients: a paradigm for practitioners in all surgical specialties

There is growing interest in complementary and alternative medicine (CAM) amongst the general population. Little information is available on CAM use in otolaryngology patients in the UK. Despite concerns over safety, efficacy and cost-effectiveness, CAM use is common amongst ENT patients. Patients perceive these medications as possible boosters to their immune system. It is becoming increasingly important that health care providers in all specialties ask their patients about CAM use and are aware of the implications it carries. The objective is to study the prevalence and pattern of CAM use among adult and paediatric ENT patients in a UK teaching hospital. A cross-sectional study was done by sending anonymous questionnaire to all outpatient and elective inpatients over a 3-month period. Response rate was 73% (1,789/2,440). Prominent demographics: female, married, over-50 s. Sixty percent had used CAM, 35% in last year. Most common herbs: cod liver oil (n = 481), garlic (n = 255), cranberry (n = 224); non-herbal: massage (n = 287), acupuncture (n = 233), aromatherapy (n = 170). Most commonly cited reasons for using CAM: general health, enhanced immunity and prevention/treatment of common illnesses like the common cold, asthma and bodily aches and pains.