Is the observation of patients with sleep-apnea-syndrome after surgery of the upper airway in an intensive care unit generally necessary?

BACKGROUND: Although it is known that after surgery of the nose and/or the paranasal sinuses serious complications can arise for patients suffering from Sleep-Apnea-Syndrome (SAS), there exists no general recommendation for postoperative care of these patients. This retrospective analysis is dealing with the question whether it is generally necessary to observe SAS-patients after nasal surgery including intubation in an Intensive Care Unit (ICU). PATIENTS AND METHODS: 24 Patients of the ORL-Dept., Marienkrankenhaus Hamburg, suffering from SAS underwent surgery of the nose, the paranasal sinuses and/or the pharynx including total intravenous anesthesia (TIVA) during the period of 1. 10. 2000 until 1. 5. 2004. SAS was diagnosed in 6 cases due to defined clinical criteria and in 18 cases due to the polysomnographic findings in the sleeping laboratory's examination. All patients were observed postoperatively for one night in an ICU. The anesthesia protocol and the intensive care curve of each patient were systematically evaluated with special regard of the following parameters: Risk factors (Body Mass Index; other diseases, ASA-classification), premedication drugs, duration of the surgery, drugs for pain relief, lowest O2-saturation of blood, lowest heartrate, highest systolic blood pressure, adverse effects, intensive care interventions. RESULTS: Intensive care interventions were never needed. 2 patients received a low dosage of oxygeninsufflation via a face mask, in 5 cases calcium-antagonist drugs were administered due to high blood pressure and in 1 case Metamizole administration was necessary due to high temperatures. An accompanying bradycardia of the same patient was treated by administration of Atropine. The lower average O2-saturation was 93.6 +/- 1.7 % (Minimum value: 89 %). The maximum systolic blood pressure was 165.8 +/- 21.2 mm Hg and the lowest average heart rate was 65.4 +/- 13.2 bpm. CONCLUSIONS: Patients suffering from a mild to moderate SAS do not need a general postoperative surveillance in an ICU if the chosen form of anesthesia is considered concerning this sickness.     

Evaluation of smell and taste in patients with Wegener’s granulomatosis

Although a reduced olfactory/gustatory function affects patients in all parts of life, this problem has not received much attention in Wegener’s granulomatosis (WG). The aim of this study was to assess the smell/taste function of WG patients. Demographic data of 16 WG patients (9 males, 7 females) were obtained. They all subjectively assessed their taste/smell function on visual analogue scale. Olfactory/gustatory functions of the patients were tested with ‘Sniffin’ Sticks and ‘Taste’ strips, respectively. The results were then compared with those from sex and age-matched control group (n = 16) and normative data. WG patients subjectively assessed their olfactory (p = 0.03) and gustatory (p = 0.02) function to be lower than control group. All the olfactory scores (odour identification, odour discrimination and threshold) in both genders were significantly below the scores in the control group. WG patients were hyposmic. For taste (total taste score, as well as scores for the qualities sweet, sour, salty and bitter), WG patients did not significantly differ from controls and were normogeusic. However, the gustatory scores showed the tendency of reduction as compared to the control group. In conclusion, WG patients truly suffer from olfactory/taste dysfunction, but this is worse with olfaction. It is, therefore, imperative that physicians should make their patients to be aware of these sensory dysfunctions and educate them on methods to cope with it for better quality of life.     

Evaluation of the predictive role of neutrophil/lymphocyte ratio in the diagnosis of lymphoma in patients with asymptomatic and ısolated cervical lymphadenopathy

IntroductionThe diagnostic approach to patients with isolated asymptomatic cervical lymphadenopathy varies between excisional biopsy and follow-up. When the anamnesis, physical examination, laboratory and imaging findings are not sufficient to identify the etiology, an excisional biopsy is performed for the differential diagnosis between early-stage lymphoma and infectious or reactive causes. If the excisional biopsy, which may have some complications, is not performed, it may delay the diagnosis of lymphoma. This diagnostic challenge could be avoided by predictive markers.ObjectivesThis study was planned to determine the predictive value of neutrophil/lymphocyte ratio in the diagnosis of Hodgkin and non-Hodgkin limphoma in patients with asymptomatic, isolated cervical limphadenopathy and underwent excisional biopsy.MethodsA total of 90 patients between the years 2016 ? 2019 admitted to our clinics due to asymptomatic isolated cervical lymphadenopathy, present in at least 4 weeks with lympho nodes in pathological dimensions persisting in the cervical region, were included to our study. An excisional lympho node biopsy was performed in all 90 patients.ResultsOf the 90 patients who underwent excisional biopsy; 34 were diagnosed as reactive lymphadenopathy 30 were non-Hodgkin linphoma, and 26 were Hodgkin linphoma. A total of 56 (62.2%) patients were diagnosed as lymphoma, either Hodgkin or non-Hodgkin, while 34 patients (38.8%) were diagnosed as reactive lymphadenopathy. The median age, total whiteblood count, neutrophil count of the lymphoma groups were significantly higher than reactive lymphadenopathy group, whereas the lymphocyte count was significantly lower in the lymphoma patients. The median neutrophil/ lymphocyte ratio was 1.7 in the reactive lymphadenopathy group, 3.5 in the non-Hodgkin limphoma group, and 3.0 in the Hodgkin limphoma group (p <  0.001).ConclusionAccording to the results of our study, neutrophil/lymphocyte ratio was significantly higher in patients who were admitted with isolated asymptomatic lymphadenopathy and were diagnosed with lymphoma, and who were diagnosed with early-stage Hodgkin and non- Hodgkin lymphoma compared to those who were found to have reactive lymphadenopathy. Neutrophil/lymphocyte ratio, which is a low-cost, fast and easy-to-access test, has a predictive value in the diagnosis of lymphoma in patients with asymptomatic lymphadenopathy.     

Does quality of life predict long-term survival in patients with head and neck cancer?

OBJECTIVE: To assess whether pretreatment and posttreatment quality of life (QOL) is associated with long-term survival in patients with head and neck cancer. DESIGN: Ten-year follow-up of an inception cohort. SETTING: Regional tertiary referral center. PATIENTS: The study included 200 consecutive patients with primary epithelial head and neck cancer. INTERVENTIONS: Quality of life and several recognized risk factors for death were assessed prospectively using the Auckland QOL questionnaire before treatment and 12 months after treatment; survival was determined at 10 years. MAIN OUTCOME MEASURES: Survival and odds of death (hazards ratio) were measured. RESULTS: At 10 years, 136 patients (68%) were deceased, 48 patients (24%) were alive, and the status of 16 patients (8%) was unknown. Median survival was 6 years (interquartile range, 4.4-7.7). Before treatment, patients with low QOL had no significantly increased odds of death (hazard ratio, 1.4; 95% confidence interval, 0.8-2.4). In contrast, after treatment, patients with low QOL at 1 year had significantly increased odds of death (2.5; 95% confidence interval, 1.4-4.3; P = .001) even after adjustment for covariates. CONCLUSIONS: Findings suggest potential survival benefits from improvements in QOL. However, the observed associations between survival benefit and QOL at 1 year may be confounded by comorbidity, which was not measured and deserves further investigation.     

Epidemiologic analysis of patients with laryngeal and hypopharyngeal cancer treated in the Department of Otolaryngology in Białystok from 1986-1999

Epidemiological analysis of patients with the larynx cancer, who were treated in the Department of Otolaryngology in Bia?ystok from 1996 to 1999 was performed. The following aspects were assessed: a) number of patients, b) gender, c) age, d) place of living, e) primary site of the tumour. The results in years 1996-1999 were compared with the earlier published results in years 1986-1994. Altogether 1431 patients (1340-93.6% males and 91-6.4% females) in that period and there were similar numbers of hospitalizations every year. Among patients there were 28-33% farmers, 41-46% labourers, 5-9% white collar workers, the others were old age pensioners. 55-59% patients came from the rural areas and 41-45% patients from urban areas. The most common site of the primary tumour was the supraglottic region (831-58.1%), then glottis (421-29.4%) and rarely in the subglottic region (5-0.3%). Hypopharynx was the tumor primary site in 174 (12.2%) patients. The analysis showed that the numbers of patients with cancer of the larynx or hypopharynx are similar in each year. A constant increase in number of female patients; coming from the rural area, farmers or labourers was found. Increasing incidence rate of supraglottic tumours and little decrease in the number of glottic tumours were also found.     

Hippocrates the otolaryngologist: an epidemiological analysis of ear–throat–nose diseases in the Corpus Hippocraticum

Abstract

Introduction: Hippocrates, a Greek physician during the fifth century BC., is often considered the father of medicine. The Corpus Hippocraticum comprising of 58 volumes was attributed to him alone for a long time. Nowadays, it is considered that several authors contributed to its creation between 450 and 150 BC., so over a period of 300 years. The objective of our study was to develop a nosological classification of all passages treating head and neck diseases.

Material and methods: We read and analyzed all volumes of the Corpus Hippocraticum in French translation and extracted all passages dealing with oto–rhino–laryngological and maxillo-facial conditions (n?=?65). We classified all pathologies into five distinctive nosological groups: traumatic, infectious, malformation, cancerous and inflammatory

Results: Traumatic diseases represented 36.9% (n?=?24), infectious 52.3% (n=?34), malformation 0% (n?=?0), cancerous 11.5% (n?=?1) and inflammatory 9.3% (n=?6). These results represent the living conditions of this era, during which diseases were mostly of infectious or traumatic nature (wars, physical labor and recreational sporting activity, living together on close quarters, etc.).

Conclusion: The meticulously detailed observations of the corpus give us a precious insight into the early perception of diseases, their progression and early attempts of treatment.     

Reconstruction of the upper lip,columella and premaxilla with an extended Abbé flap: report of a case

The resection of malignant tumours affecting the upper lip, columella, premaxilla and/or caudal septum requires reconstructive surgery, which does not always produce satisfactory results-either aesthetic or functional. We have designed a modification of the Abbé flap consisting of the extension of the distal portion of the latter over the chin, and the inclusion of a fragment of rib cartilage in this portion of the flap. The columella is reconstructed in this way, and the cartilage serves to buttress the pyramid tip and prevent its collapse. A case is reported, with good aesthetic and functional results. Other surgical procedures are discussed, analysing their advantages and inconveniences.     

Cost and morbidity of MRSA in head and neck cancer patients: what are the consequences?

Methicillin resistant Staphylococcus aureus (MRSA) has become a prevalent nosocomial pathogen worldwide. The objectives of this study were to assess the morbidity and cost associated with the treatment of head and neck cancer patients who become colonized or infected with MRSA following major surgical procedures. We present a retrospective review of patients who underwent major surgery for head and neck cancer over a one year period and who then became MRSA positive in the post-operative period. MRSA affected 25/55 (45 per cent) patients who underwent major head and neck procedures during the period studied. The mean time of diagnosis was 13 days post-surgery. Morbidity included cellulitis, osteomyelitis and MRSA pneumonia. Thirteen of the patients who became MRSA positive (52 per cent of the MRSA group) required further surgery including plate removal, new flap formation and wound debridement as a result of the infection. Average in-hospital stay was almost three times more prolonged for patients who became MRSA positive compared to those who did not have MRSA. The costs of the first hospital stay were over three times more in the MRSA-positive group of patients. Antibiotic costs were increased by pound 2470 per patient because of MRSA. The extra stay in hospital, together with extra days in intensive care, extra medical and nursing care and additional costly antibiotic treatment, led to major cost implications and loss of health service resources in the unit. MRSA infection is a serious cause of morbidity in any surgical group of patients and this study focuses on the consequences for treatment of head and neck cancer patients in particular.     

Initial staging of head and neck squamous cell carcinoma. What is the place of bronchoscopy and upper GI endoscopy?

European Archives of Oto-Rhino-Laryngology - To determine the place of bronchoscopy and upper GI endoscopy in the initial staging of head and neck squamous cell carcinoma (HNSCC). A 10-year...     

Clinical evaluation of a commercially available oral moisturizer in relieving signs and symptoms of xerostomia in postirradiation head and neck cancer patients and patients with Sjögren's syndrome

A major complication of irradiation therapy for head and neck cancer is salivary gland dysfunction and xerostomia. The purpose of this clinical investigation was to evaluate the effects of a commercially available oral moisturizer (Optimoist) on salivary flow rate, symptoms of xerostomia, oral pH, oral microflora, and swallowing in postirradiation head and neck cancer patients (XRT) and patients with Sj?gren's syndrome (SS). Subjects who were post-XRT and subjects with SS (n = 24; mean age = 54.1) discontinued their use of any salivary substitute or moisturizer for 2 weeks prior to entering the study. Baseline whole unstimulated saliva was collected for 5 minutes using a standard sialometric technique. Candida albicans and Lactobacillus cultures were performed using kits from Orion Diagnostica, Inc., and a pH analysis was performed on the salivary sample using a Markson (model 00663) pH meter. Swallowing was assessed by clinical measures by videofluoroscopic techniques. Several subjective assessments were performed to evaluate symptoms of xerostomia. Subjects were instructed in the use of a daily diary and to use only the provided article ad libitum for a period of 2 weeks. After the 2-week period, the results indicated significant subjective and objective improvements in signs and symptoms of xerostomia. Whole unstimulated salivary flow rate improved from (mean +/- SEM) 0.1150 +/- 0.02 to 0.2373 +/- 0.09 mL/min. Salivary pH did not change. Global subjective improvement in xerostomia improved in 58% of the subjects. Candida colonization decreased in 43% of the subjects. There was no change in Lactobacilli colonization. Swallowing objectively improved in 75% of subjects. These results indicate significant improvement in both signs of hyposalivation and symptoms of xerostomia with the use of Optimoist in postirradiation head and neck cancer patients and patients with SS.     

The causes of the development of cicatrical stenosis of the larynx and trachea in the patients presenting with Guillain-Barré syndrome

The problem of rehabilitation of the patients presenting with post-intubation stenosis of the larynx and trachea remains unresolved despite the development of new methods for the diagnostics and treatment of this condition. One of the indications for long-term artificial lung ventilation is the severe form of Guillaine-Barret syndrome associated with paralysis of breathing muscles, development of bulbar symptoms, and disturbances of trophic process in the skin and mucous membranes. However, prolonged (mean 26 days) artificial lung ventilation may result in the formation of many-layer stenosis of the larynx and trachea whereas disturbed trophic processes in the skin and mucous membranes coupled to inadequate innervation complicate the postoperative conditions of the patients and promote restenosis of the tracheal lumen.     

Do the laryngopharyngeal symptoms and signs ameliorate by empiric treatment in patients with suspected laryngopharyngeal reflux?

Objectives

In clinical practice, antireflux medication is given almost always empirically without pH monitorization. We aimed to evaluate the improving effect of empiric antireflux treatment on layngopharyngeal symptoms and signs in patients with gastroesophageal reflux (GER) and suspected laryngopharyngeal reflux (LPR) according to reflux symptom index (RSI) and reflux finding score (RFS).

Methods

GER was determined by esophagogastroduedonoscopy and biopsy in 127 patients. RSI and RFS were calculated for each patient. The patients with a pathology other than LFR which may be responsible from laryngopharyngeal symptoms and signs were excluded from the study. Fifty patients whom were thought to have LPR according to RSI and RFS comprised the study group. After 12-weeks of antireflux treatment, RSI and RFS were calculated again. The statistical analyses were made according to the changes in the severity and frequency of each symptom and sign.

Results

There was statistically significant improvement in RSI and RFS after treatment when compared with initial scores. There was statistically significant improvement in severity of all symptoms and signs. Although there was quantitively decrease in frequency of some signs and symptoms, complete resolution of the disease was not observed generally.

Conclusion

Empiric antireflux treatment according to RSI and RFS is an effective method. Antireflux treatment has a significant improving effect on laryngopharyngeal symptoms and signs. There may be needed longer times of treatment for complete resolution of symptoms and signs.     

Usefulness of self-report questionnaires for psychological assessment of patients with tinnitus and hyperacusis and patients’ views of the questionnaires

Objective: The objective was to determine the relevance and applicability of psychological questionnaires to patients seeking help for tinnitus and/or hyperacusis. Design: This was a questionnaire-based survey. The following questionnaires were administered: Generalised Anxiety Disorder (GAD-7), Short Health Anxiety Inventory (SHAI), Mini-Social Phobia Inventory (Mini-SPIN), Obsessive Compulsive Inventory-Revised (OCI-R), Panic Disorder Severity Scale-Self Report (PDSS-SR), Patient Health Questionnaire (PHQ-9) and Penn State Worry Questionnaire-Abbreviated version (PSWQ-A). In addition, a patient feedback questionnaire was completed asking about the extent to which each questionnaire was relevant to them and how strongly they would recommend its use in the assessment of patients with tinnitus and hyperacusis. Study Sample: A total of 150/402 consecutive patients seen in a one-year period completed the questionnaires. Results: 65% of patients had abnormal scores for one or more of the questionnaires. All questionnaires except the PDSS-SR were rated as relevant and recommended for use. Conclusions: The GAD-7, SHAI, Mini-SPIN, OCI-R, PSWQ-A and PHQ-9 are recommended for evaluation of psychological problems for patients seeking help for tinnitus and/or hyperacusis. Abnormal results on these questionnaires may indicate the need for referral for possible treatment of psychological problems.     

Round window microcatheter administered microdose of gentamycin: an alternative in the treatment of tinnitus in patients with Menière's disease

BACKGROUND: In this study, we review the results of Menière's disease treatment using microdose gentamycin delivered directly to the round window using a new microcatheter system. PATIENTS AND METHODS: 11 patients were treated by 1.25 mg gentamycin on the 3rd and 7th day after insertion of the new microcatheter at the niche of the round window membrane, while a second group of 7 patients was treated by a gentamycin dosage of 1 microliter/h continuously applied by a minipump over a period of 10 days. Electrocochleography was derived by an integrated electrode and the microcatheter was removed after 10 days. The results were analysed with a follow-up ranging from 6 to 12 months. RESULTS: In 15 of 18 patients (83%) tinnitus was improved significantly throughout the follow-up period. Vertigo was eliminated in all patients, and pressure was relieved in 17 of 18 (94%). CONCLUSIONS: These preliminary data suggest that gentamycin delivered by the Round-Window-Microcatheter is a safe and effective treatment for the reduction of tinnitus, vertigo, and pressure associated with Menière's disease.     

The treatment of polypous suppurative rhinosinusitis in the patients presenting with the severe and moderate aspirin triad

The present study inluded 22 patients presenting either with very severe or moderately severe aspirin triad 17 of whom suffered exacerbation of chronic polypous suppurative rhinosinusitis. The reference group comprised 10 patients with exacerbation of chronic polypous suppurative rhinosinusitis in the absence of concomitant bronchial asthma. The control group included 25 practically healthy subjects having neither chronic somatic diseases nor ENT organ pathology. Conventional otorhinolaryngological examination of the patients was supplemented by cytological studies of the secretion from maxillary sinuses (MS) and inranasal mucosa, measurement of viscosity and pH of MS secretion. It was shown that eosinophil count in the MS secretion was several-fold higher than that in the secretion from nasal cavity mucosa . Polypotomy in the nasal cavity was performed after the preoperative treatment of the patients using sparing procedures, such as laser irradiation and a radiofrequency loop. This approach allowed to reduce the probability of enhancement of bronchial resistance during surgery and in the immediate postoperative period; moreover, it made it possible to continue puncture therapy of patients experiencing exacerbation of the chronic inflammatory process in the maxillary sinuses.     

Randomised,multi-centre study of the usefulness of the heat and moisture exchanger (Provox HME<Superscript>®</Superscript>) in laryngectomised patients

This study included 60 patients (30 in Nice and 30 in Reims), who were randomised between a control group that used no device of this type and a group equipped with the Provox HME^®. After 3 months of using the device, a notable improvement was found which was statistically significant with regard to cough (P = 0.00174) and to bronchorrhoea (P = 0.0031), and very close to achieving significance with regard to breathing effort. An overall improvement in the prosthetic (tracheo-oesophageal) voice was found in the 21 patients using the HME^® and a voice prosthesis for all of the parameters studied. The device was used daily by 80% of the patients of whom 42% used it day and night at the end of the 3 months. Seven patients suffered from minor cutaneous intolerance (of whom 6 had received radiation therapy), which did not require the use of the HME^® to be abandoned (PC). After 3 months, patients were asked the following questions: “Do you feel any improvement?”: 92% of affirmative answers; “Are you breathing better?”: 88% of affirmative answers; “Are you speaking more easily?”: 81% had experienced speech improvement. The general adaptation to the device was judged to be satisfactory for 95% of the patients after 3 months. The results of this randomised study show an improvement in the pulmonary symptoms and in the prosthetic voice after 3 months of using Provox HME^®. This light and easy-to-use device appears to us to afford a significantly improved quality of life for laryngectomees and should be offered systematically during functional rehabilitation of these patients.