A new classification for septal perforation and effects of treatment methods on quality of life

IntroductionSeptal perforation is a condition characterized by loss of cartilage and/or bony structures along with the mucoperichondrium and mucoperiosteum lining them. The etiology includes a history of nasal surgery or trauma, nose picking, bilateral septal cauterization, overuse of nasal sprays, cocaine abuse, vasculitis, and malignancies.ObjectiveComparison of quality of life in patients with septal perforation after conservative or surgical treatment, and a new approach for the determination of the diameter of the perforation from a different point of view.MethodsThe diameter of septal perforation, total vertical diameter of septum, and horizontal diameter of the perforation were measured in a total of 34 patients. Nineteen of the patients underwent surgical septal perforation repair, and 15 of them received septal button application. The patients were asked to complete the Glasgow Benefit Inventory quality of life questionnaire.ResultsThe septal perforation successfully healed in 18 of 19 patients who underwent surgical treatment. The quality of life scores were statistically significantly higher in the surgical treatment group when compared to the button group (p < 0.05).ConclusionThe septal perforation classification we propose would be beneficial for providing realistic dimensions, treatment methods, and surgical techniques.     

Disease-specific quality of life after septoplasty and bilateral inferior turbinate outfracture in patients with nasal obstruction

Introduction

Septal deviations might cause nasal obstruction and negative impact on the quality of life of individuals. The efficacy of septoplasty for treatment of septal deviation and the predictors of satisfactory surgical outcomes remain controversial. Technical variability, heterogeneity of research samples and absence of a solid tool for clinical evaluation are the main hindrances to the establishment of reliable statistical data regarding the procedure.

Factors influencing the quality of life of children with cochlear implants

IntroductionThe multidimensional impact of hearing loss on the various demands of life in children using cochlear implants is represented by variables that can influence the hearing, language and quality of life outcomes of this population.ObjectiveTo evaluate the factors influencing the quality of life of children with cochlear implantation, considering age, hearing age, age at evaluation, hearing skills, spoken language, family degree of receptiveness, schooling and socioeconomic status of the parents.MethodsParticipated 30 children using cochlear implants, aged 6 to 12 years and their respective parents. The children were evaluated by the categories auditory performance, by language category, and by the children with cochlear implants: perspectives parents questionnaire. Parents were assessed by the family involvement scale.ResultsThe cochlear implant impacted the quality of life of the children, with more significant results on the increase of the social relations domain and the decrease of the family support domain. Overall, the increase of the age in the evaluation, better hearing and language skills, the mother's level of schooling and the family receptiveness correlated with the quality of life of children with cochlear implants.ConclusionThe influencing factors that correlated with the quality of life of the implanted children were the child's older age at the evaluation, the better hearing and language skills, the mother's level of schooling and the family receptiveness.     

Use of the long-term quality of life assessment in the decision to indicate surgery in patients with chronic rhinosinusitis

IntroductionQuality-of-life questionnaires have been used to support decision-making in patients with chronic rhinosinusitis in the past decade. The choice of treatment in practice, however, also considers the patient's decision.ObjectiveTo assess the long-term quality of life of patients with chronic rhinosinusitis who decided to avoid surgery.MethodsThis is a prospective longitudinal study with a group of patients with chronic rhinosinusitis, with and without indication for surgery, with application of the questionnaire SNOT-22 in two periods: between 2011 and 2012 and between June and August 2016, via email.ResultsData were collected from 42 patients, of which 13 presented indications for surgery and 29 were not indicated for surgery. The average quality of life score was 42.1 (±16.4) in the group with an indication for surgery and 40.6 (±23.4) in the group without this indication, p = 0.84. All the patients were assessed by a single doctor with blinding in relation to the initial score. No differences were detected between the groups. The impact of the chronic rhinosinusitis was reduced even among the patients with the indication for surgery. Both groups scored over 40.ConclusionThis study can help predict the impact of the chronic rhinosinusitis over time and better adjust expectations with non-surgical treatment.     

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal

IntroductionAfter post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections.ObjectiveThe aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections.MethodsThe study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination.ResultsThe group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients’ assessment (p < 0.001) and by nasal endoscopic examination (p = 0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required.ConclusionThe use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.     

Effects of distractors on upright balance performance in school-aged children with attention deficit hyperactivity disorder,preliminary study

Introduction

Attention deficit hyperactivity disorder is a common impairing neuropsychiatric disorder with onset in early childhood. Almost half of the children with attention deficit hyperactivity disorder also experience a variety of motor-related dysfunctions ranging from fine/gross motor control problems to difficulties in maintaining balance.

Retrospective analysis of skin complications related to bone-anchored hearing aid implant: association with surgical technique,quality of life,and audiological benefit

Introduction

The bone-anchored hearing aid is an effective form of auditory rehabilitation. Due to the nature of the implant, the most common complications are skin related. A number of alternative surgical implantation techniques have been used to reduce the frequency and severity of skin complications, including the U-shaped graft and the linear incision.

Endoscopic observation of different repair patterns in human traumatic tympanic membrane perforations

Introduction

In the last decade, there has been an increasing use of biomaterial patches in the regeneration of traumatic tympanic membrane perforations. The major advantages of biomaterial patches are to provisionally restore the physiological function of the middle ear, thereby immediately improving ear symptoms, and act as a scaffold for epithelium migration. However, whether there are additional biological effects on eardrum regeneration is unclear for biological material patching in the clinic.

The Portuguese version of “The Utrecht questionnaire for outcome assessment in aesthetic rhinoplasty”: validation and clinical application

Introduction

The evaluation of surgical outcomes measured by patient satisfaction or quality of life is very important, especially in plastic surgery. There is increasing interest in self-reporting outcomes evaluation in plastic surgery.

Endoscope-assisted retrosigmoid approach in hemifacial spasm: our experience

IntroductionThe use of surgical decompression of facial hemispasm due to the loop in the internal auditory canal is not always accepted due to the risk related to the surgical procedure. Currently a new surgical technique allows surgeons to work in safer conditions.ObjectiveTo report the results with endoscope-assisted retrosigmoid approach for facial nerve microvascular decompression in hemifacial spasm due to neurovascular conflict. The surgical technique is described.MethodsWe carried out a prospective study in a tertiary referral center observing 12 (5 male, 7 female) patients, mean age 57.5 years (range 49–71) affected by hemifacial spasm, that underwent to an endoscope assisted retrosigmoid approach for microvascular decompression. We evaluated intra-operative findings, postoperative HFS resolution and complication rates.ResultsHemifacial spasm resolution was noticed in 9/12 (75%) cases within 24 h after surgery and in 12/12 (100%) subjects within 45 days. A significant (p < 0.001) correlation between preoperative historical duration of hemifacial spasm and postoperative recovery timing was recorded. Only 1 patient had a complication (meningitis), which resolved after intravenous antibiotics with no sequelae. No cases of cerebrospinal fluid leak, facial palsy or hearing impairment were recorded. Hemifacial spasm recurrence was noticed in the only subject where the neurovascular conflict was due to a vein within the internal auditory canal.ConclusionsThe endoscope assisted retrosigmoid approach technique offers an optimal visualization of the neurovascular conflict thorough a minimally invasive approach, thus allowing an accurate decompression of the facial nerve with low complication rates. Due to the less invasive nature, the procedure should be considered in functional surgery of the cerebellar pontine angle as hemifacial spasm treatment, specially when the procedure is performed by an otolaryngologist.     

Functional outcomes and survival of patients with oral and oropharyngeal cancer after total glossectomy

IntroductionCancer of the oral cavity and oropharynx presents aggressive behavior and its diagnosis is, in most cases, performed in advanced stages. Total glossectomy is a therapeutic option in locally advanced cancer, and the only one in the recurrent or residual disease, after chemoradiotherapy.ObjectiveTo evaluate the clinical-epidemiological profile, postoperative complications, survival rates and functional aspects of patients with oral cavity and oropharynx cancer after total glossectomy.MethodsIt was a retrospective study where 22 patients were included with oral cavity and oropharyngeal cancer after total glossectomy at the Hospital Regional do Vale do Paraíba, em Taubaté, São Paulo.ResultsAll patients were male, with a median age of 57 years, most of tumors are located in the tongue and floor of the mouth and classified as stage IVa. Total glossectomy as initial treatment was performed in 18 and as salvage in four patients. The major pectoralis myocutaneous flap was used for reconstruction in all cases. The main postoperative complication was wound infection and salivary fistula.ConclusionOverall survival was 19% and cancer-specific survival was 30.8% in five years. Eight patients were rehabilitated for exclusive oral feeding without the dependence tracheostomy and enteral tube, all with an overall survival greater than 15 months.     

Auditory and language skills of children using hearing aids

IntroductionHearing loss may impair the development of a child. The rehabilitation process for individuals with hearing loss depends on effective interventions.ObjectiveTo describe the linguistic profile and the hearing skills of children using hearing aids, to characterize the rehabilitation process and to analyze its association with the children's degree of hearing loss.MethodsCross-sectional study with a non-probabilistic sample of 110 children using hearing aids (6–10 years of age) for mild to profound hearing loss. Tests of language, speech perception, phonemic discrimination, and school performance were performed. The associations were verified by the following tests: chi-squared for linear trend and Kruskal–Wallis.ResultsAbout 65% of the children had altered vocabulary, whereas 89% and 94% had altered phonology and inferior school performance, respectively. The degree of hearing loss was associated with differences in the median age of diagnosis; the age at which the hearing aids were adapted and at which speech therapy was started; and the performance on auditory tests and the type of communication used.ConclusionThe diagnosis of hearing loss and the clinical interventions occurred late, contributing to impairments in auditory and language development.     

Quality of life and cochlear implant: results in adults with postlingual hearing loss

Introduction

Considering the variability of results found in the clinical population using a cochlear implant, researchers in the area have been interested in the inclusion of quality of life measures to subjectively assess the benefits of the implantation.

Benchmarks for the Dichotic Sentence Identification test in Brazilian Portuguese for ear and age

IntroductionDichotic listening tests should be used in local languages and adapted for the population.ObjectiveStandardize the Brazilian Portuguese version of the Dichotic Sentence Identification test in normal listeners, comparing the performance for age and ear.MethodsThis prospective study included 200 normal listeners divided into four groups according to age: 13–19 years (GI), 20–29 years (GII), 30–39 years (GIII), and 40–49 years (GIV). The Dichotic Sentence Identification was applied in four stages: training, binaural integration and directed sound from right and left.ResultsBetter results for the right ear were observed in the stages of binaural integration in all assessed groups. There was a negative correlation between age and percentage of correct responses in both ears for free report and training. The worst performance in all stages of the test was observed for the age group 40–49 years old.ConclusionsReference values for the Brazilian Portuguese version of the Dichotic Sentence Identification test in normal listeners aged 13–49 years were established according to age, ear, and test stage; they should be used as benchmarks when evaluating individuals with these characteristics.     

Pediatric airway reconstruction: results after implementation of an airway team in Brazil

IntroductionSince development of pediatric intensive care units, children have increasingly and appropriately been treated for complex surgical conditions such as laryngotracheal stenosis. Building coordinated airway teams to achieve acceptable results is still a challenge.ObjectiveTo describe patient demographics and surgical outcomes during the first 8 years of a pediatric airway reconstruction team.MethodsRetrospective chart review of children submitted to open airway reconstruction in a tertiary university healthcare facility during the first eight years of an airway team formation.ResultsIn the past 8 years 43 children underwent 52 open airway reconstructions. The median age at surgery was 4.1 years of age. Over half of the children (55.8%) had at least one comorbidity and over 80% presented Grade III and Grade IV subglottic stenosis. Other airway anomalies occurred in 34.8% of the cases. Surgeries performed were: partial and extended cricotracheal resections in 50% and laryngotracheoplasty with anterior and/or posterior grafts in 50%. Postoperative dilatation was needed in 34.15% of the patients. Total decannulation rate in this population during the 8-year period was 86% with 72% being decannulated after the first procedure. Average follow-up was 13.6 months. Initial grade of stenosis was predictive of success for the first surgery (p = 0.0085), 7 children were submitted to salvage surgeries. Children with comorbidities had 2.5 greater odds (95% CI 1.2–4.9, p = 0.0067) of unsuccessful surgery. Age at first surgery and presence of other airway anomalies were not significantly associated with success.ConclusionsThe overall success rate was 86%. Failures were associated with higher grades of stenosis and presence of comorbidities, but not with patient age or concomitant airway anomalies.     

Investigating quality of life and coping resources after laryngectomy

Surgical procedures and in particular laryngectomy can become a life-saving treatment for patients with laryngeal or hypopharyngeal cancer, but can result in permanent damage. Clinical observation suggests that patients vary considerably in their ways of dealing with this new situation and in their ability to cope. The aim of our interdisciplinary group was to investigate the quality of life of laryngectomy patients and learn about their perceptions, situation and coping mechanisms. The development of an appropriate study design and a measurement strategy is presented. We investigated 29 laryngectomized patients who had joined the local self-help group. The patients were free from tumour disease and were mostly married with children, retired from work and had not graduated from high school. Assessment of the quality of life was performed with the European Organization for Research on Treatment of Cancer questionnaires QLQ-C30 and H+N35 and additional open questions. Analysis of the acquired data showed that family support was judged most important for overcoming the problems of disease and treatment. Deficits in this area were highly correlated with a low overall quality of life. Financial problems resulted because of the high percentage of retirement before or after therapy. We suggest that perioperative support taking these facts into consideration can result in an improved coping process. Further prospective studies are needed to reveal the effect of such measures. Received: 28 May 2001 / Accepted: 6 June 2001     

Comparison of long-term functional results between standard supracricoid laryngectomy and modified technique with sternohyoid muscle

IntroductionLaryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities.ObjectiveThe aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid muscle.MethodsIn total, 29 male patients (average years 58.20 ± 9.00 years; range 41–79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared.ResultsThe mean maximum phonation time was 8.68 ± 4.21 s in Group A and 15.24 ± 6.16 s in Group B (p > 0.05). The S/Z (s/s) ratio was 1.23 ± 0.35 in Group A and 1.08 ± 0.26 in Group B (p > 0.05); the voice handicap index averages were 9.86 ± 4.77 in Group A and 12.42 ± 12.54 in Group B (p > 0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73 ± 3.08 in Group A and 13.64 ± 1.49 in Group B (p > 0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21 ± 4.11, 32.21 ± 6.85, and 20.14 ± 2.17 in the Group B, and 29.20 ± 2.54, 32.4 ± 4.79, and 19 ± 1.92 in Group A, respectively.ConclusionAlthough there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes.     

Validation of a Portuguese version of the health-related quality of life measure for active chronic otitis media (COMQ-12)

Introduction

Measuring the impact on quality of life, especially after the beginning of the treatment, is becoming increasingly important in healthcare.

The Portuguese version of the RhinoQOL Questionnaire: validation and clinical application

IntroductionRhinosinusitis constitutes an important health problem, with significant interference in personal, professional, and social functioning. This study presents the validation process of the Portuguese version of the RhinoQOL, to be used as a routine procedure in the assessment of patients with chronic rhinosinusitis.ObjectiveTo demonstrate that the Portuguese version of the RhinoQOL is as valid as the English version to measure symptoms and health-related quality of life in chronic rhinosinusitis.MethodsThe Portuguese version of the RhinoQOL was administered consecutively to 58 patients with chronic rhinosinusitis with and without nasal polyps, assessed for endoscopic sinus surgery. A follow-up survey was completed three months after surgery. Statistical analysis was performed to determine its psychometric properties.ResultsFace and content validity were confirmed by similar internal consistency as the original questionnaire for each sub-scale, and strong correlation between individual items and total score. The questionnaire was easy and quick to administer (5.5 min). At three months, there was a significant decrease from baseline for all sub-scale scores, indicating clinical improvement, with an effect size considered as large.ConclusionThis study provides a questionnaire that is equivalent to the original English version, with good responsiveness to change, which can be especially valuable to measure the outcome of surgery.