Posterior glottic pathology

In infants and children, pathology in the posterior glottis is usually congenital or acquired due to endotracheal intubation. Diagnostic errors and omissions are less likely to occur with an anaesthetic technique where no endotracheal tube is used, where the posterior commissure and arytenoids are deliberately separated by a laryngoscope and where movements of the vocal cords and arytenoids are carefully assessed.     

Noise pathology in otorhinolaryngology

Intensive industrial noise is an adequate stimulus of the hearing organ. Obviously, it can cause occupation-related hypoacusis in noise exposed workers. Pathological changes in other organs and systems that accompany cochlear neuritis are poorly studied; however, it seems that they have no noise-determined specific features. Clinical and provocative examinations have shown that noise, which exceeds maximal allowable levels, produces a significant effect on the development of the symptom-complex of pathological disorders, including hypoacusis, neurodynamic and neurocirculatory changes, hypertensive disease. Combination of disorders in the cardiovascular and central nervous function should be viewed as a pathology induced by intensive industrial noise, i. e. as an independent nosological form of pathology termed noise disease.     

Vocal pathology of teachers

Out of 100 teachers referred to a phoniatric department for dysphonia, we recorded 11 dysfunctional lesion-free dysphonias, 86 dysphonias with lesions, 3 post-surgical dysphonias, 76 patients referred for a dysphonia with a modification of the spoken voice, and only 3 for the singing voice. 96 suffered from vocal fatigue, and in the course of the clinical examination 85 patients presented a faulty vocal attitude. The most frequent lesions were nodules and para-nodular formations. Vocal re-education was prescribed in 90 cases, and laryngeal microsurgery in 25 cases. The other medical therapies are not be overlooked, such as physiotherapy, thermal cures, psychiatric treatment, treatments of the terrain, and endocrinic treatments. A vocal examination, better information and vocal training of future teachers will make it possible to obviate such disorders.     

Screening for retrocochlear pathology

In 1982, 135 patients were screened for possible retrocochlear pathology, by means of an investigation protocol consisting of caloric test, impedance audiometry and brainstem response audiometry (BRA). A combination of the first two of these procedures had an unacceptably low prognostic accuracy. BRA indicated retrocochlear pathology in 8 and was inconclusive in 4 cases. Enhanced computer tomography revealed an intracranial tumour in 4 of the former, while no space-occupying lesion could be demonstrated in the remainder nor in the 4 patients with inconclusive BRA. BRA is the best single test for screening of this patient category.     

Sinonasal pathology and headaches

Primary headaches or other chronic headaches can be triggered by sinonasal pathologies, or variations within the sinonasal tract. Establishing a cause and effect relationship between certain sinonasal conditions and chronic headaches can justify sinonasal surgery for the relief of headaches and provide considerable relief to a subgroup of patients with chronic headaches resistant to medical treatment. A prospective study on 204 patients undergoing sinonasal surgery for an apperent symptomatic sinonasal pathology was conducted to determine the incidence and types of headaches in sinonasal patients preoperatively, the presence of potential sinonasal triggering mechanisms, and postoperative headache relief when such triggers are removed. The relationship between potential triggers and postoperative relief is analysed to determine a possible link. Headache was a major complaint in 50% of these patients and the overall incidence of primary type headaches was 25.5% (52 of 204 patients). Postoperatively, 83.4% of the patients expressed improvement of the headaches (85/102). High scores of preoperative Sinonasal Headache Quotient (SNHQ), obtained through a general questionnaire and endoscopic/radiologic work up seems to correlate well with postoperative relief of headaches (p < 0.0001), as well as a well defined lesion site and an ipsilateral pain localization (p < 0.02). A detailed sinonasal analysis of chronic headache patients may help identify a subgroup with potential sinonasal triggers and these patients may experience considerable relief of headache following surgery.     

Assessment of salivary gland pathology

At this institution, inflammatory problems and calculous disease are evaluated by plain films or sialography. CT can be used for stone evaluation but is not usually necessary. Although CT has been the mainstay of tumor evaluation, magnetic resonance imaging has several very definite advantages and is likely to supercede CT as the procedure of choice.