Ear pain and its treatment in hypobaric chamber training in the Japan Air Self-Defense Force.

BACKGROUND: We have documented that ear pain is the most prevalent physiologic incident during hypobaric chamber training in the Japan Air Self-Defense Force. Ear pain may increase also in flight in the future because it is closely related to allergic rhinitis. Therefore, it is very important to know the characteristic of ear pain and the efficacy of its treatment. METHODS: The incidence of ear pain was calculated in each training profile from 1990 to 1998. Type III chamber flight records were further analyzed for the characteristics of ear pain: relationship with a trainee occupational category, time of occurrence of ear pain, and efficacy of treatment. RESULTS: Of 17,935 exposures, 740 trainees (4.1%) had ear pain. Of 7,047 trainees, 429 (6.1%) complained of ear pain especially in Type III, totaling 625 times. Fighter pilots and cargo pilots complained of ear pain one twelfth and one third the number of times, respectively, compared with passengers. Of the 625 episodes, 616 (98.6%) occurred during descent. Three kinds of treatment were administered until the pain was relieved in the following order: Valsalva maneuver, Politzer bag, and decompression. The efficacy rates were 35.8, 92.3, and 83.9%, respectively. Only 5 trainees (0.07%) could not complete training due to ear pain despite treatment. CONCLUSION: The combination treatment of Valsalva maneuver, Politzer bag, and decompression is very effective for relieving ear pain encountered during hypobaric chamber training. A health specialist needs to understand ear pain and its treatment in hypobaric environment such as aircraft.     

Postoperative Schmerztherapie nach Hals-Nasen-Ohren-ärztlichen Eingriffen

The degree of pain following different types of ear–nose–throat surgery varies greatly and must be adjusted on an individual basis. Post-operative pain therapy can be classified into basic pain therapy and additive pain therapy (as needed). Effective pain therapy can lead to lower morbidity and to considerable economic advantages. The subjective pain intensity experienced by patient should be the basis for the dose adaptation and is essential for rapid recovery.     

Intrathecal narcotics for relief of pain from head and neck cancer.

We describe our experience with nine patients with head and neck pain of malignant origin who were treated with continuous low-dose intrathecal morphine via a lumbar catheter and implantable subcutaneous drug delivery pump. All patients had failed prior attempts at oral narcotic pain control due to either poor pain control or intolerable side effects. Using a visual analogue scale where the most severe pain is rated as 10 and no pain is rated as 0, the mean visual analogue scale was reduced from 7.6/10 (range, 5 to 10/10) before implantation to 1.9/10, 2.0/10, and 0.5/10 at 1 week, 1 month, and 2 months after implantation, respectively. Complications were acceptable. We conclude that intrathecal administration of morphine is a safe and effective means of pain control. This method deserves serious consideration in patients with intractable pain secondary to head and neck malignancy.     

Sinogenic facial pain: diagnosis and management

Most patients who present to an otorhinolaryngology clinic with facial pain and headaches believe they have sinusitis. There is an increasing awareness that neurologic causes are responsible for a large proportion of patients with headache and facial pain. If facial pain and pressure is the primary symptom, it is unlikely to be caused by sinus disease in the absence of any nasal symptoms or signs. Patients with facial pain who have no objective evidence of sinus disease are unlikely to be helped by surgery. Most patients with pain caused by sinusitis respond to medical therapy.     

Postoperative pain after paediatric adenoidectomy and differences between the pain scores made by the recovery room staff, the parent and the child

CONCLUSIONS: The parents scored the postoperative pain higher than the nurse. The nurse's score correlated better than the parent's to the child's score. There was no gender difference regarding the pain after adenoidectomy. OBJECTIVE: To evaluate the correlation between the parents and the health care professionals regarding how postoperative pain is estimated and to identify age and gender differences regarding the pain after adenoidectomy. PATIENTS AND METHODS: The study included 100 children aged 3-10 years scheduled for adenoidectomy. The nurse and the parent assessed the postoperative pain of the child at different time intervals using a visual analogue scale (VAS). The child rated its pain by using the Wong-Baker FACES pain rating scale. RESULTS: The postoperative pain scores were higher at 10 min after the operation than after 30 min. The parents scored the pain higher than the nurse did, but there was still a strong correlation between the observers' rating of the pain. The correlation between the nurse's and the child's assessments was stronger than the correlation between the parent's and the child's assessments. There was no gender difference in how the pain was perceived by the child. The parents tended to score the pain higher with older age of the child.     

Prevalence of nasal mucosal contact points in patients with facial pain compared with patients without facial pain

A cohort of 973 consecutive attendants at a rhinology clinic was studied prospectively and divided into patients without facial pain (n = 566, 58 per cent) and patients with facial pain (n = 407, 42 per cent). The prevalence of nasal mucosal contact points was the same in both groups, being four per cent in patients with nasal contact points without facial pain and four per cent in patients with facial pain. A contact point is defined as when contact remains after topical decongestion. Of the 18 patients with facial pain, nine had a spur contacting the lateral nasal wall and nine had a middle turbinate contacting the septum. These 18 patients were followed up for a mean of two years and two months. In the light of their treatment and response the following diagnoses were made: five had tension-type headache, six had midfacial segment pain, one had migraine, two had cluster headache and four had purulent nasal disease. Of the four with unilateral symptoms, two had a contact point on the contralateral side. Eleven of these 18 patients responded to medical treatment for tension-type headache or midfacial segment pain, migraine and cluster headache, three patients were better after surgery for coexisting purulent nasal disease and one patient had a spur removed surgically and remained better at 2 years follow-up, whereas three patients were no better after the same procedure. The results demonstrate that the prevalence of nasal contact points in patients with facial pain is the same as in those within pain. Surgery undertaken to remove mucosal contact points for facial pain is usually unnecessary as the aetiology of this facial pain appears to be a more central processes.     

Pain management in advanced carcinoma of the head and neck.

Although pain is one of the most feared consequences of cancer, pain management is rarely discussed in the literature on head and neck cancer. The pain experienced by patients with head and neck malignancies, of a biologic origin, is compounded by the emotional distress caused by alterations in function and cosmesis. Control of pain is possible, but an effective program must include more than pain medication. A current treatment program is presented, based on scientific study and clinical experience. The most helpful pain medication is immediate-release, liquid morphine sulfate (20 mg/mL) administered every 4 hours. A nonsteroidal anti-inflammatory drug may also be used and it may decrease the amount of morphine necessary. Stool softeners must be provided, and anti-nausea medication is often given. Steroid drugs are regularly used to increase appetite, decrease edema, and enhance the patient's sense of well-being. Factors related to the selection and dosage of medications are discussed.     

Managing temporomandibular joint syndrome

Pain in the temporomandibular joint is primarily responsible for the morbidity often associated with this syndrome. Of the 448 cases in this study, 48% presented as ear pain and 46% complained of either headache, sinus pain, or neck pain. Temporomandibular joint pain and mastication muscle tenderness elicited with palpation were frequent physical findings. In this review, temporomandibular joint syndrome was successfully managed in 75% of 448 cases with conservative treatment consisting of patient education, heat, massage, non-narcotic analgesics, and occlusal splints. Seventeen percent were referred to dentists for restorations or orthodontics. The success rate for the 6% who underwent diagnostic arthroscopy and/or open joint surgery with disc replacement was 67%. Therefore, patients with ear pain or head and neck pain require an objective evaluation of medical history and physical examination to obtain the correct diagnosis and subsequent correct treatment and pain relief. Early diagnosis helps to prevent changes in the joint that can become irreversible with intractable pain. Surgery is reserved for those patients who fail to respond to conservative management.     

Potential oscillation elicited by i.v. olfaction and its applicability as an objective clinical olfaction test

OBJECTIVE: Alinamin has long been applied in Japan for testing i.v. olfaction and to diagnose olfactory disorders. The test is subjective, each subject being asked about the presence or absence of olfaction. The credibility of the answers is highly questionable in some cases; as a result, the reliability of the test is poor. Recent studies demonstrated an induced electric potential in the scalp during i.v. olfactory testing. Some patients complain of the pain of the injection during i.v. olfactory testing; therefore, the effect of this pain must be considered with respect to measurement of the i.v. olfaction-elicited potential (IVOP). MATERIAL AND METHODS: This investigation involved 179 subjects with various olfaction levels. Each subject received an Alinamin injection; the elicited potential amplitude was compared before and after the injection and the increasing ratio (IR) was computed. Gender, age, level of olfactory disorder, the presence or absence of olfaction and the presence or absence of the pain of injection were considered as factors affecting IR. RESULTS: IR showed significant increases in groups characterized by the presence of olfaction as well as in groups reporting pain of injection. The test subjects were further divided into four groups based on their olfaction and pain of injection patterns as follows: Group A, no smell and no pain; Group B, smell and no pain; Group C, no smell and pain; and Group D, smell and pain. Subjects exhibiting no recognizable olfaction or pain of injection (Group A) revealed no increase in IVOP following injection. Subjects with either recognizable olfaction or pain of injection (Groups B and C) exhibited a slight increase in IVOP following injection. Subjects with both noticeable olfaction and pain of injection (Group D) demonstrated a significant increase in IVOP following the injection with a very high value of IR (>2). Furthermore, there were significant differences between the four groups in terms of IR level, with the exception of Groups B and C. CONCLUSIONS: Olfaction is largely involved with the generation of IVOP. However, pain resulting from injection of Alinamin is considered to be a significant factor. IVOP showed significant effectiveness for diagnosing olfactory disorders in cases who did not experience pain of injection.     

Comparison of postoperative pain: piezoelectric device versus microdrill

Piezosurgery^® is a recently developed system for cutting bone with microvibrations. The objective of this study was to compare the severity of pain over the first 10 postoperative days in a group of 70 patients who underwent intact canal wall mastoidectomy, with the piezoelectric device, and to compare the results with traditional method by means of microdrill (70 patients). The subjective perception of pain was evaluated on a scale from 0 to 10, such that 0 represented no pain and 10 represented maximum pain; the severity was recorded as null when the score was 0; slight, when it was 1–4; moderate, when it was 5–7; or severe, when it was 8–10. Compared with microdrill, the patients that underwent surgery with the piezoelectric device showed a significant (P < 0.05) lower postoperative pain on day 1 (52 vs. 26 patients presented a slight pain, 12 vs. 37 presented a moderate pain, and 6 vs. 7 presented a severe pain) and day 3 (68 vs. 44 patients presented a slight pain, 2 vs. 23 presented a moderate pain, and 0 vs. 3 presented a severe pain). These results highlight as the piezoelectric device is a safe and minimally invasive tool.     

Problem of cancer-related pain in laryngological practice

In most laryngological cancer patients chronic pain can be successfully treated with pharmacological drugs, using different combinations of analgetic drugs with adjuvant analgetics. However chronic pain, mainly cancer-related pain, what lost its physiological alerting function should be especially sufficient treated to avoid patient degradation of social and professional position, psychical disorders and performance status. The understanding of cancer-related mechanisms and ethiopathogenesis is a cornerstone of successful therapy. The aim of this study is to summarize data of mechanisms of cancer-related pain and methods of treatment of chronic, neoplasmatic "total pain", using orders of analgetic ladder and coanalgetics. Dynamic characteristic of pain in laryngological patients with malignant neoplasms localized in head and neck region require very exact, individual monitoring and treatment.     

Association of radiological evidence of frontal sinus disease with the presence of frontal pain

BACKGROUND: Rhinosinusitis is a common cause of frontal pain. We evaluated the relationship between frontal pain and the type and degree of frontal sinus disease in chronic rhinosinusitis (CRS) patients. METHODS: Inclusion criteria were presence of frontal sinusitis or frontal recess obstruction on computed tomography scan. Office notes and operative reports were reviewed to determine the presence and location of frontal pain and categorization of sinus disease. RESULTS: Two-hundred seven patients were identified with frontal recess obstruction and/or frontal sinus disease. Thirty-one of 37 frontal mucocele patients (84%) had frontal pain. Twenty of 70 polyp patients (29%) had frontal pain, with only 7 of 38 patients (18%) with complete frontal opacification having pain. In patients with CRS without polyps or mucocele, 59 of 100 (59%) had frontal pain, with 21 of 38 (55%) with complete opacification having pain. This difference between the distribution of frontal pain was significant (p < 0.005) among the mucocele, polyp, and nonpolypoid CRS groups. Additionally, among nonmucocele CRS groups exhibiting complete opacification, there was a significant difference in proportion of patients exhibiting frontal pain (p < 0.005). When the nonmucocele groups (i.e., polypoid and nonpolypoid CRS patients) were combined and stratified for disease extent, a difference in the distribution of frontal pain was found (p < 0.025), with the mild-to-moderate thickening group showing the highest proportion of pain. CONCLUSION: Frontal pain was more common in nonpolypoid CRS patients than in polyp patients. Furthermore, in nonmucocele CRS, patients with mild-to-moderate thickening exhibited more frontal pain.     

Prevalence of facial pain in 108 consecutive patients with paranasal mucopurulent discharge at endoscopy

We undertook a prospective observational study of 108 consecutive patients with endoscopic paranasal mucopurulent secretions. Only 31 patients (29 per cent) had facial pain. In 20 (65 per cent), the endoscopic site of purulent secretions corresponded to the site of pain. In those with facial pain, 74 per cent had nasal obstruction, 68 per cent had objective hyposmia and 84 per cent had mucopurulent rhinorrhoea. In the 31 patients with facial pain, 19 (61 per cent) became symptom free following medical treatment. The remaining 12 patients underwent surgery and their symptoms resolved, except for one patient with a tension-type headache and another with pain of unknown cause. Most patients with purulent secretions from the paranasal sinuses do not have facial pain; therefore, chronic rhinosinusitis is not synonymous with pain. Patients with sinogenic facial pain usually have endoscopic findings that correlate with the site of pain, and the majority also have other nasal symptoms. Chronic infective rhinosinusitis usually responds to medical therapy, and the remainder resolve with surgery.     

Stylalgia and its surgical management by intra oral route -clinical experience of 332 cases

Stylalgia is a pain syndrome occurring in connection with on elongated or malpositioned styloid piocess and is more common than generally thought. 332 cases of stylalgia were diagnosed over a period of 15 years. The charcteristic symptoms were chronic throat pain during swallowing with referred otalgia or referred pain to cheek or lower part of neck associated with foreign body sensation in throat. Movements of head or act of deglutition initiates or increases the pain The diagnosis of stylalgia is based on symptoms, palpation of enlarged styloid process mtraorally in the tonsillar region and elicitation of similar nagging throat pain or pain in the neck or foreign body sensation in the throat. Confirmation of enlarged styloid process is always done by radiological examination of styloid process per orbital view. Bilateral enlargement of tyloid process were found in 196 patients (59.03%) and unilateral enlargement was found in 136 (40.96%) patients. All the patients were operated under local anaesthesia by intra oral route without any complications.     

Additional use of acupuncture to NSAID effectively reduces post-tonsillectomy pain

Post-tonsillectomy swallowing pain is a common and distressing side effect after tonsillectomy and thus of great clinical interest. Up until now, there is no randomized controlled patient- and observer-blinded study evaluating the efficacy of acupuncture against swallowing pain after tonsillectomy. We therefore compared the potency of specific verum acupuncture points related to a Chinese medical diagnosis in reducing postoperative swallowing pain with non-specific control points on the body as well as a non-acupuncture group who received standard medication only. The standardized pain therapy after tonsillectomy was orally administered nonsteroidal anti-inflammatory drugs (NSAID) (diclofenac 3 × 50 mg oral). The patients (n = 123) treated with NSAID were asked about their acute pain after taking a sip of water between the first and fifth postoperative day. Participants’ pain was assessed using visual analog (VAS) [zero (0) for no pain up to ten (10) for the acute reported outset pain] before and 20 min, 1, 2 and 3 h after acupuncture treatment or standard pain medication, respectively. The functional assessment of diagnosis and treatment point-combination occurred by means of the “Heidelberg Model” of Traditional Chinese Medicine (TCM). Verum acupuncture lead to a significant additional pain relief. In comparison to the acupuncture, they also reported an average of 3 h duration of adequate pain-relief past taking the NSAID. This trial strongly supports a specific acupuncture scheme for the treatment of postoperative swallowing pain after tonsillectomy. It may particularly serve as an alternative pain treatment in case of NSAID intolerances.     

Similarities between severe tinnitus and chronic pain

The symptoms and signs of severe tinnitus and chronic pain have many similarities and similar hypotheses have been presented regarding how the symptoms are generated. Pain and tinnitus have many different forms. The severity of the symptoms of both varies within wide limits, and it is not likely that all forms have the same pathology. Some individuals with severe tinnitus perceive sounds to be unpleasant or painful. This may be similar to what is known as allodynia, which is a painful sensation of normally innocuous stimulation of the skin. Many individuals with chronic pain experience a worsening of their pain from repeated stimulation (the "wind-up" phenomenon). This is similar to the increasingly unpleasant feeling from sounds that are repeated that many individuals with severe tinnitus experience. There are also similarities in the hypotheses about the generation of pain and tinnitus. Although less severe tinnitus may be generated in the ear, it is believed that severe tinnitus in many cases is caused by changes in the nervous system that occur as a result of neural plasticity. Acute pain caused by tissue injury is generated at the site of injury but chronic pain is often generated in the central nervous system, yet another similarity between chronic pain and severe tinnitus. The changes in the nervous system consist of altered synaptic efficacy including opening of dormant synapses. For pain, this is believed to occur in the wide dynamic range neurons of the spinal cord and brain stem. Less is known about the anatomic location of the changes that cause severe tinnitus but there are indications that it may be the inferior colliculus. It is also possible that other auditory systems than the classical ascending pathways may be involved in severe tinnitus.     

Postoperativer Schmerz nach Mittelohrchirurgie

Background

The purpose of this work was to assess postoperative pain management after middle ear surgery.

Materials and methods

In a prospective clinical study, 73 adults were evaluated on the first postoperative day after middle ear surgery using the questionnaire of the Germany-wide project QUIPS (quality improvement in postoperative pain management). The main outcome measures were patients’ characteristics, pain parameters, outcome, and pain therapy process parameters.

Results

Overall, pain on the first postoperative day was mild. Pain management consisted predominately of premedication with midazolam, remifentanil intraoperatively, metamizole in the recovery room and on the ward. Otherwise healthy patients suffered significantly more from pain than patients with reduced general condition in univariate and multivariate analyses. About half of the patients demanded pain relief on the ward. Despite immediate pain management with nonopioids and/or opioids, these patients had significantly more maximal pain and were less satisfied with overall pain therapy than patients not demanding pain therapy.

Discussion

QUIPS is a simple tool to evaluate the quality of in-hospital postoperative pain management following ear surgery. Pain on the first postoperative day seems to be moderate but should be improved for patients demanding more analgetics despite baseline pain therapy on the ward.     

Prevalence of back and neck pain amongst ENT consultants: national survey

Back and neck pain is an established occupational disease for many professions. No previous studies have shown the association of back and neck pain with ENT surgery. Our objective was to determine the prevalence of neck and back pain in ENT consultants in the United Kingdom and which sub-specialties were most at risk. A national survey from 325 ENT consultants in the UK revealed that 72 per cent had either back pain or neck pain or even both. Of those with pain 53 per cent attributed their symptoms directly to ENT surgery. Highest figures were received from otologists, related to microscope work and prolonged sitting. The importance of these findings has demonstrated the lack of awareness and adequate training to prevent long-term disability in ENT surgeons.     

The relationship between body posture and pressure in occluded maxillary sinus of man

One of the most common symptoms in sinusitis is pain over the infected cavity increasing when the patient is bending forward or lying down. It is commonly thought that this increase in pain is a result of increased pressure in the paranasal cavities when bending forward. In this investigation we have found that changing the body position from sitting to recumbent or even to "head between knees" gives a manometrical pressure rise in the sinus that is too small to cause a pressure-mediated pain. The pain is probably caused by a dilation in the blood vessels of the infected mucosa when the patient is bending forward or lying down.