Epiglottic dysfunction during deglutition in patients with dysphagia

Among 250 patients with dysphagial complaints, 83 had dysfunction of the epiglottis as revealed by high-speed cineradiography. Nineteen patients had a totally immobile epiglottis and of these 11 had concomitant pharyngeal constrictor paresis. Sixteen of the patients with immobile epiglottis had misdirected swallowing. An absence of the second movement of the epiglottis during deglutition was registered in 53 patients. Thirteen of these had pharyngeal constrictor paresis and 45 had misdirected swallowing. In 11 patients the epiglottis attained an obliquity of 30 degrees to 90 degrees as seen in the anteroposterior projection during its second movement. One of these had a pharyngeal constrictor paresis, while four had misdirected swallowing. The results of this study indicate that epiglottic dysfunction is common among patients with dysphagia and is often accompanied by other functional abnormalities.     

Two years of a program in hearing-aid-related services

A program of hearing-aid-related services is described in which a dispenser of hearing aids visits an audiology facility on a regular basis as a supplier. Surveys to assess the program were conducted during a two-year period. Of the 128 patients who participated in the study, 89% continued wearing their hearing aids during the first year and 86% during the second year. The adjustment period of about 30 days with an accompanying orientation program was crucial. Ear mold considerations and use of the hearing aid during noisy situations constituted two major problem areas. Five aids were returned to the factory during the adjustment period, six during the first year, and 15 during the second year. Group work in hearing aid evaluation and orientation was a positive factor.     

下咽癌和喉癌的多重癌

对下咽，喉鳞癌患者的多重癌实况进行回顾性调查。方法 对１９８０年－１９９５年１６年间头颈部外科受诊者下咽癌１２５例，喉癌１８４例进行了分析，其中男２７６例，女３３例。结果３０９例患者中７９例发生多重癌。多重癌发生部位共１０１处，其中１７例三重癌，１例四重癌，的多重癌以食管癌和胃癌居多；喉癌，尤以声门型喉癌的多重癌以肺癌为主，声门上型喉癌的口咽，食管和胃多重癌的发生率较声门型喉癌为高。     

Riesgo de aparición de segundas neoplasias y neoplasias sucesivas en pacientes con un tumor índice de cabeza y cuello

ObjectiveTo analyse the incidence of appearance of second and successive neoplasms in a cohort of head and neck squamous carcinoma patients.Material and methodsWe conducted a retrospective study with 4,458 patients with an index tumour located in the head and neck diagnosed during the 1985-2016 period. We evaluated the incidence of appearance of second neoplasms and successive neoplasms over a period of 30 years.ResultsDuring the follow-up, 1,203 patients (27.0%) had a second neoplasm, 242 patients (5.4%) a third neoplasm, 58 patients (1.3%) a fourth neoplasm, and 8 patients (0.2%) 5 or more successive neoplasms. The incidence of appearance of second neoplasms was 3.5% per year, remaining relatively constant throughout the follow-up period. The patients with a second neoplasm had a higher risk of appearance of a third neoplasm, and those with a third neoplasm had a higher risk of a fourth. Seventy-eight percent of the second neoplasms, 88% of the third neoplasms, and 89.6% of the fourth neoplasms appeared in locations epidemiologically related to tobacco and alcohol use.ConclusionsSecond neoplasms after a head and neck index tumour appeared at a constant rate of 3.5% per year throughout the entire follow-up period.     

Influence of extensive functional endoscopic sinus surgery (FESS) on facial growth in children with cystic fibrosis. Comparison of 10 cephalometric parameters of the midface for three study groups

OBJECTIVES: To determine the impact of FESS after the first and before the second growth spurt on facial growth and in particular of the maxilla. DESIGN: Prospective study of 23 patients with cystic fibrosis, 13 patients requiring extensive endoscopic spheno-ethmoidectomy (FESS) because of massive nasal polyposis, with a follow-up of at least 10 years. SETTING: A cystic fibrosis referral centre in an academic tertiary pediatric hospital. PATIENTS: At the time the standard cephalometric measurements were performed all patients were adults with cystic fibrosis. One group of patients underwent FESS during facial growth (N=9), a second group of patients had no previous surgery (N=9), and in a third group FESS has been performed after the second growth spurt (N=5). RESULTS: No statistically significant differences (Kruskall-Wallis test) were found in the cephalometric measurements of these three patient groups. CONCLUSIONS: Extensive FESS after the first and before the second growth spurt has no impact on the outcome of facial growth.     

Bilateral stapedectomy: association between first- and second-ear surgical findings and their effects on the second-ear outcome

OBJECTIVES: We assessed the association between first-ear and second-ear surgical findings in patients undergoing second-ear stapedectomy for bilateral otosclerosis and the impact of such findings on the audiometric outcome of the second ear. METHODS: A retrospective chart review of all stapedectomy patients who underwent stapes surgery by one of two surgeons in a single tertiary referral institution from 1962 to 2001 was performed, and those patients who underwent bilateral stapedectomy were identified. Patient demographic data, surgical findings, procedure performed, and preoperative and postoperative audiometric data were recorded. RESULTS: A total of 459 patients (918 ears) underwent bilateral stapedectomy for bilateral otosclerosis during the study period, of whom 426 had complete data for analysis. The finding of a white or obliterated footplate in the second ear was significantly higher if the first ear had this disease manifestation (p < .001, chi2 test). The association between a second drill-out's being performed and a drill-out in the first operation was significant (p < .001, chi2 test). Statistical analysis identified that those who underwent a drill-out procedure had a 2.9-fold increase in unsuccessful outcome in comparison to those who did not have a drill-out (odds ratio, 2.89; 95% confidence interval, 1.41 to 5.89). Facial nerve anomalies were infrequently encountered, affecting only 23 patients, of whom 3 had bilateral abnormalities. The finding of an overhanging or dehiscent facial nerve in the second ear was significantly more likely if such an abnormality was identified during the first procedure (23% versus 2.5%; p = .005, Fisher's exact test). CONCLUSIONS: Second-ear hearing results are poorer in those who require a drill-out of this ear, and this is more likely to be required if a drill-out was required in the first ear, regardless of a successful outcome of the first procedure. Patients should be aware of the reduced likelihood of success in these cases and be counseled regarding risks and benefits of second-ear surgery based, in part, on the findings from the first ear. This study confirms that bilateral advanced footplate obliteration and overhanging or dehiscent facial nerves may be anticipated in patients found to have these abnormalities during first-ear stapedectomy.     

p53 mutation in histologically normal mucosa of the aero-digestive tract is not a marker of increased risk for second primary carcinoma in head and neck cancer patients

Head and neck cancer patients are at high risk for developing second primary tumors. This is known as field cancerization of the aero-digestive tract. In a previous study, we showed that patients with multiple primary tumors were more likely to have p53 mutations in histologically normal mucosae than patients presenting with an isolated tumor. Based on this observation, we postulated that p53 mutations in normal tissue samples of patients bearing a single primary tumor could have a clinical value as a biomarker for the risk of developing second primary tumors. Thirty-five patients presenting with a single primary tumor were followed-up for a median of 51 months (range 1 month to 10.9 years) after biopsies of histologically normal squamous cell mucosa had been analyzed for p53 mutations with a yeast functional assay at the time of the primary tumor. During this follow-up, recurrences and non-sterilization of the primary tumor, occurrence of lymph node metastases, and of second primary tumors were evaluated. Sixteen (45.7%) patients were found to have p53 mutations in their normal squamous cell mucosa, and 19 (54.3%) patients showed no mutation. No relationship was found between p53 mutations and the occurrence of evaluated events during follow-up. Notably, the rate of second primary tumors was not associated with p53 mutations in the normal squamous mucosa. The correlation between p53 mutations in histologically normal mucosae and the incidence of second primary tumors is generally low. The benefit of analyzing p53 mutations in samples of normal squamous cell mucosa in every patient with a primary tumor of the head and neck is doubtful.     

Electrophysiological study of Bell palsy: electrically elicited blink reflex in assessment of prognosis.

The electrically elicited blink reflex was tested serially in 81 patients with Bell palsy. In 56 patients, the reflex returned before excitability of the distal segment of the facial nerve was lost, indicating recovery of conduction across the involved segment before distal degeneration. These patients generally showed a good clinical recovery within a few months after onset. The reflex latency, however, was considerably prolonged during the first month, suggesting demyelination or other pathologic change. The reflex latency was reduced considerably during the second month and returned to normal levels during the third or fourth months. In the remaining 25 patients, direct response to facial nerve stimulation became unelicitable before reflex responses returned, indicating distal degeneration of the nerve. In this group of patients, clinical recovery was prolonged and generally incomplete.     

Panendoscopy as a screening procedure for simultaneous primary tumors in head and neck cancer

Head and neck cancer is often associated with second primary neoplasms. These cancers most commonly involve other regions of the head and neck, esophagus, and lung. The majority of cases are also squamous cell carcinomas. In view of this rather frequent occurrence of multiple primary cancers and how they adversely affect the patient's survival, it becomes imperative to analyze how the clinician can intervene effectively. One such approach is to detect multiple primaries as early as possible. As such, panendoscopy as a part of the tumor-staging procedure has been advocated by many investigators to search for simultaneous second primary malignant neoplasms in patients presenting with head and neck cancer. In a 24-month period, data were gathered from 127 consecutive patients referred to University Hospital, Ghent with previously untreated, squamous cell carcinomas of the head and neck. One hundred-eighteen patients underwent an endoscopic examination under general anesthesia, during which 4 simultaneous second primary tumors were found in 3 patients. This represents an incidence of 3.4% of simultaneous second primary neoplasms. The results for the different parts of the endoscopy are discussed and compared with literature findings. Guidelines are given for the initial evaluation of the head and neck cancer patient.     

Late recurrence or radiation induced cancer of the larynx.

Twenty five patients with squamous carcinoma of the glottis (T1a and T1b) had undergone successful irradiation. Many years later they developed a so-called late recurrence. The following evidence shows that these 'late recurrences' are radiation induced: the interval of 5-18 years (mean 9.9 years) between the first and the second cancer correlates with the interval seen usually in radiation induced malignancy, recurrences generally appear during the first 2 years after irradiation, all the second cancers were found in the previously irradiated area, in patients treated by surgery only, late recurrences are extremely rare, histological examination clearly shows that the second carcinoma originates from the squamous epithelium and not from dormant nests in the deeper layers of the vocal cord. These factors should be taken into consideration when deciding between surgical or radiation therapy in younger patients with high life expectation.     

双眼有晶体眼后房型人工晶体植入手术患者两次手术疼痛对比

目的 比较表面麻醉下的有晶体眼后房型人工晶体(ICL)植入手术双眼术前紧张程度、术中疼痛及配合度等,分析双眼疼痛是否存在差异及寻找可能的原因,探寻ICL手术双眼之间的合理间隔期。 方法 入组分次行双眼ICL手术的120例患者中男18例、女102例,将患者随机分为间隔1 d组及间隔1周组,患者双眼按间隔时间行ICL手术,所有手术均为表面麻醉,经透明角膜切口行ICL植入术。每只眼术前使用视觉模拟(VAS)量表评价患者紧张程度,术中术者评估患者配合程度,记录手术耗时,术后使用VAS量表评估患者术中疼痛程度及整体满意度,患者估计手术耗时。统计学分析比较双眼评分变化和组间差异,并探求疼痛程度与患者一般资料的关系。 结果 不管是在间隔1 d组还是间隔1周组,患者在第二眼手术时紧张程度较前减轻(1 d组:P<0.01;1周组:P=0.011),疼痛程度明显升高(两组均:P<0.01),手术满意程度变差(两组均P=0.001),估计手术时间延长(两组均P<0.01)。在第二眼术中,患者配合程度变差(两组均:P=0.002),但并不会导致手术耗时的增加(1 d组:P=0.481;1周组:P=0.499)。在第二只眼手术时,有相当一部分患者回忆第一只眼的疼痛会偏低,在1周组差异有统计学意义(1 d组:P=0.082;1周组:P=0.011)。间隔1周组较间隔1 d组第二只眼相对于第一只眼的各指标的变化程度更大,但各指标组间比较差异无统计学意义(P>0.05)。多因素回归分析及多独立样本非参数检验显示,年轻的、未生育的人倾向于有较高的疼痛程度。 结论 第二只眼ICL手术患者的紧张程度较第一只眼降低,疼痛较前增加,配合度降低,这可能主要与心理因素有关,需要积极进行心理干预。双眼手术间隔1 d时和间隔1周时差别不大,可以根据需要选择ICL手术双眼间隔期。     

Comparison of direct vision and video imaging during bronchoscopy for pediatric airway foreign bodies

Rigid ventilation bronchoscopy is a most useful means of detecting and removing foreign bodies in the airway. We performed a retrospective study of 114 children who had undergone such a procedure during a 12-year period. During bronchoscopy, 48 of these patients had been examined under direct vision and 66 by videotape recording. We found that the positive rate on first-look direct vision was 93.8% and the positive rate on first-look video imaging was 89.4%. The lower positive rate during the first-look examination by video imaging might be attributable to the facts that it is safer and that it provides a better visual field, which can encourage operators to choose video ventilation bronchoscopy, either as a diagnostic or therapeutic tool. In addition, three foreign-body-negative patients in the direct-vision group under-went a second procedure, and a foreign body was found in all three. Only one of the video-imaging patients under-went a second procedure, and no foreign body was found. The difference in the positive rates after the second procedure was statistically significant (p < 0.05). This might be attributable to the higher success rate with video imaging following the first procedure, which significantly reduced the need for a second look and the possibility of overlooked or residual foreign bodies. The condition of the mucosa postprocedurally was described in every case after video imaging but after only 41.7% of the direct-vision cases--a statistically significant difference (p < 0.001). Video imaging provides the physician with a clear, magnified view of the area under examination. It allows for later review of the videotape when necessary, and it reduces the risk that residual foreign-body material will remain in the airway.     

双瓣式发音钮全喉切除术后发音重建

为解决无喉者发音问题，从１９９３年３月～１９９６年１１月，利用自行研制的双瓣式喉发音钮及安装器为全喉切除术后患者应用９７例，其中男８４例，女１３例，年龄３５岁～７８岁。全喉切除术后Ⅰ期安装２０例，Ⅱ期安装７７例，效果满意，患者均能清晰说话，语言流利，地方语言特色明显。部分患者能唱歌，随访观察：在发音钮有效使用时间（１～２年）内，配戴满２年者６８例，发音有效率１００％，误咽率为零。该发音钮具有安装、更换方便，使用时间长，术后不用鼻饲等优点，为无喉者发音提供了又一有效途径。     

双瓣式发音钮全喉切除术后发音重建

为解决无喉者发音问题，从１９９３年３月￣１９９６年１１月，利用自行研制的双瓣式喉发音钮及安装器为全喉切除术后患者应用９７例，其中男８４例，女１３例，年龄３５岁￣７８岁，全喉切除术后１期安装２０例，Ⅱ期安装７７例，效果满意，患者均能清晰说话，语言流利，地方语言特色明显，部分患者能唱歌，随防观察：在发音钮有效使用时间（１￣２年）内，配戴满２年者６８例，发音有效率１００％，误咽率为零。该发音钮具有安装，     

Clinical evaluation of the nasal dilator Nozovent. The effect on snoring and dryness of the mouth.

When the lateral walls of the nostrils are dilated with Nozovent, inhalation requires less force, thus reducing the risk of vibrations of the soft palate creating the snoring sound. There is also less need for mouth-breathing. When 17 patients were tested during 10 nights, every second night using Nozovent, the sleeping partners noted significantly less snoring these nights than during the nights without Nozovent. The patients themselves also noted significantly less dryness of the mouth when they dilated the nostrils with Nozovent, being able to avoid mouth-breathing.     

Clinical experiences with recurrences of Bell's palsy

In a retrospective study of 2568 patients with peripheral facial palsies seen during a 10-year period, 106 (8.2%) of 1293 patients (50.4%) with Bell's palsy suffered a recurrence. A recurrence at the same side of the face was called a "recurrent" one, but was considered to be an "alternating" one at the other side. Ninety-eight patients (52 men, 46 women) were studied for this report. Of these patients, 70% suffered from a second attack of Bell's palsy within 10 years of the first attack. Fourteen patients had more than one recurrence. Of some note, 33 of the 98 patients had their second palsy in the last months of the year. Recovery of facial function after a recurrent palsy was worse in 39.6% and was 32.1% after an alternating palsy. The recovery after multiple palsies appears to be worse than after a single palsy.     

Multiple primary tumors in patients with laryngeal squamous cell hyperplasia

We analyzed retrospectively the case histories of 204 patients with squamous cell hyperplasia of the larynx for the occurrence of multiple primary tumors. All patients were grouped according to Kleinsasser's 1963 classification of laryngeal pathology. Patients with simple hyperplasia (class I) had a low risk for developing a coincidental primary tumor. The rist was 7% in patients with hyperplasia with atypia (class II) and was 15% in patients with carcinoma in situ (class III). This frequency is similar to that of our patients with glottic cancer (13%). Although no coincidental tumors were found in our female patients, the small number of females in our series made the differences in frequency between males and females not significant. This is still of interest to us because our previous study of patients with proven glottic cancers also showed that no second tumors occurred in our female patients. This difference was statistically significant. In our present study, all second tumors occurred metachronously. Our findings indicate that all patients with class III laryngeal disease (carcinoma in situ) should undergo the same aggressive search for second primary tumors, as do patients with invasive glottic cancers. This means that panendoscopy or bronchoscopy should be done at the initial work-up and also at periodic intervals during the follow-up period. We have also found that patients lacking immunoglobulin allotype Km(1) have to be followed aggressively, since these patients are at high risk of developing multiple tumors. A possible exception can be made for female patients.     

Audiologic monitoring of multi-drug resistant tuberculosis patients on aminoglycoside treatment with long term follow-up

Background

Multi-drug resistant tuberculosis has emerged as a significant problem with the resurfacing of tuberculosis and thus the need to use the second line drugs with the resultant increased incidence of adverse effects. We discuss the effect of second line aminoglycoside anti-tubercular drugs on the hearing status of MDR-TB patients.

Methods

Sixty four patients were put on second line aminoglycoside anti-TB drugs. These were divided into three groups: group I, 34 patients using amikacin, group II, 26 patients using kanamycin and group III, 4 patients using capreomycin.

Results

Of these, 18.75% of the patients developed sensorineural hearing loss involving higher frequencies while 6.25% had involvement of speech frequencies also. All patients were seen again approximately one year after aminoglycoside discontinuation and all hearing losses were permanent with no threshold improvement.

Conclusion

Aminoglycosides used in MDR-TB patients may result in irreversible hearing loss involving higher frequencies and can become a hearing handicap as speech frequencies are also involved in some of the patients thus underlining the need for regular audiologic evaluation in patients of MDR-TB during the treatment.     

Vertical component of the caloric response, including a caloric second phase provoked by positional change: a preliminary report

We measured the horizontal and vertical components of caloric nystagmus in 120 ears of 60 vertiginous patients who had moderate to vigorous caloric first-phase response in both ears, no spontaneous nystagmus, and no severe disorders in the central nervous system. We provoked a caloric first phase in the supine position with 5 ml of water at 20 degrees C for 15 seconds. We provoked a caloric second phase by changing the position of a patient from supine to sitting after the end of the first phase. The horizontal component of the caloric second phase was recorded in 108 of 120 ears (90%). The vertical component was recorded in 57 of 120 ears (48%) during the caloric first phase and in 51 of 120 ears (43%) during the caloric second phase. We suspected that the vertical component of the caloric first phase was mainly due to the inhibition of the anterior semicircular canal.     

Late recurrence or radiation induced cancer of the larynx

Twenty five patients with squamous carcinoma of the glottis (T_1a, and T_1b) had undergone successful irradiation. Many years later they developed a so-called late recurrence. The following evidence shows that these ‘late recurrences’ are radiation induced: –the interval of 5–18 years (mean 9.9 years) between the first and the second cancer correlates with the interval seen usually in radiation induced malignancy –recurrences generally appear during the first 2 years after irradiation –all the second cancers were found in the previously irradiated area –in patients treated by surgery only, late recurrences are extremely rare –histological examination clearly shows that the second carcinoma originates from the squamous epithelium and not from dormant nests in the deeper layers of the vocal cord. These factors should be taken into consideration when deciding between surgical or radiation therapy in younger patients with high life expectation.