An Internet otolaryngology referral center: a preliminary report

BACKGROUND: The aim of this study was to review our early experience with the UPenn Otolaryngology Referral Center Website, ENTConsult.org. METHODS: ENTConsult.org is an interactive website that allows a referring physician to select a University of Pennsylvania Health System otolaryngologist and share clinical information, including uploaded pictures, radiographs, and other images via the Internet. Traditional methods of long-distance consultation involve mailing clinical information, which often is slow and unwieldy, thus discouraging consultation. ENTConsult.org seeks to take advantage of Internet functionality to facilitate efficient and timely consultation regardless of any of the participants' locations. RESULTS: In this report we reviewed our initial experience with ENTConsult.org, including an overview of the website functionality and a detailed review of critical logistical considerations. CONCLUSION: The UPenn Otolaryngology Referral Center Website ENTConsult.org offers considerable promise as an avenue for long-distance referral and consultation.     

Masseter spasm and malignant hyperthermia: a retrospective review of a hospital-based pediatric otolaryngology practice.

It has been claimed that the combination of halothane and succinylcholine, commonly used for anesthetic induction during short pediatric otolaryngologic procedures, is associated with a 1% incidence of masseter spasm (MS) which may be an early sign of malignant hyperthermia (MH). An 18-month retrospective chart review of all patients undergoing general anesthesia at the Children's Hospital of Pittsburgh (n = 14, 112) was conducted to assess the incidence of MS and its management. In addition, a separate subgroup of patients identified as being at risk for MH was also evaluated. In the otolaryngology service, the incidence of developing MS was 2 of 206 (1%) in children who were anesthetized with halothane and received succinylcholine, patients were identified in the MH high-risk group, and none developed MH. The findings affirmed the risks of using this combination of anesthetic and neuromuscular blocking agents during induction and the need for establishing management guidelines.     

Quantitation and prevalence of tympanosclerosis in a pediatric otolaryngology clinic

Objective: To determine the incidence and prevalence of tympanosclerosis (TS) in patients seen in a pediatric otolaryngology clinic. Design: Prospective observational study. Setting: Tertiary care, ambulatory care clinic. Patients and other participants: We conducted a prospective observational study to determine the incidence of TS in 218 patients seen consecutively in a pediatric otolaryngology clinic for otologic and nonotologic reasons. The patient age range was 3 weeks to 30 years; 63% were male and 37% female. Of the 218 patients, 37% (81) had undergone bilateral myringotomy and tube placement (BM&T), and 35% (21) of the 81 showed signs of TS; 63% (137) of the 218 patients had no history of otologic surgery, but 12% (15) of the 137 showed signs of TS. Method: The area of the tympanic membrane affected by TS was determined by otoscopy performed by one viewer, who drew the otoscopic findings on a standardized tympanic membrane template. The area of TS was quantified in terms of percentages by digital image analysis of the scaled drawings. Results: There was a range of 0.5–59.9% involvement of the tympanic membrane with TS, with the median percentage of involvement being 4.95%. There was an increased percentage of TS with repeat BM&T. Conclusion: This observational study shows that patients who have had BM&T have a higher incidence of TS than those who have not had the surgery. However our findings also show that 38% of the patients in this study who had TS had never undergone BM&T.     

A pilot project on hospital-based universal newborn hearing screening: lessons learned

OBJECTIVE: This paper reports the performance of a newly implemented hospital-based universal newborn hearing screening programme and the challenges to the effective implementation. METHODS: Data of 4437 babies screened from April 2003 to February 2004 at Hospital Universiti Kebangsaan Malaysia was analyzed to measure the performance of the newborn hearing screening programme. Quality indicators, which include the coverage rate, initial refer rate, return for follow-up rate, ages of diagnosis and intervention were calculated. Factors contributing to poor compliance for follow-up were examined through questionnaire survey of 341 parents who did not bring their babies for the initial screening follow-up. RESULTS: The findings of this study revealed unsatisfactory performance of the hearing screening programme compared to the Joint committee of Infant Hearing recommendation [Joint Committee on Infant Hearing Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs, Pediatrics 106 (4) (2000) 798-817]. The coverage rate, initial refer rate, and return for follow-up rate were 84.64, 11.97 and 56.97%, respectively. The average age of diagnosis was 3.56 months (S.D. 1.33). Only 1 of the 16 babies identified as having hearing loss through the screening programme has been fitted with hearing aids. Delay in coming to audiological certainty was one of the reasons hampering early intervention of these children. The commonly cited reasons for not returning for screening follow-up reflect the need to create public awareness of the importance of early diagnosis and intervention of hearing loss. CONCLUSIONS: The implementation of the present screening programme needs to be reviewed. Factors contributing to its unsatisfactory performance must be identified and steps must be taken to resolve them so that early identification and intervention of permanent congenital hearing loss can become a reality.     

Day case surgery in otolaryngology: a 10-year analysis

This paper analyses the ENT day case surgery performed over the period May 1974 to May 1984 in Cardiff. The patients undergoing such surgery, the types of surgery, forms of anaesthesia, travelling considerations, seasonal variation and admission rate are examined. The problems of list organization, patient selection and attendance are examined in detail in a 12-month period from May 1981 to May 1982.     

Facial-motion analysis with a video and computer system: a preliminary report

HYPOTHESIS: To investigate the feasibility of a video and computer-assisted system for evaluating the temporal and spatial aspects of facial motion during selected facial expressions in a pilot group of six normal adults. Evaluation of the diverse medical and surgical treatments for facial paralysis and paresis cannot occur until objective, reliable, and sensitive measures of the spatial and temporal aspects of facial function at specific facial landmarks are developed. METHODS: Facial motion at predetermined facial locations was assessed using a commercially available computer-interactive motion analysis system, which is based on videography principles. The displacement, velocity, and acceleration data were averaged across all trials and subjects. Time plots also were obtained for the left versus right side. RESULTS: The greatest mean maximum displacement (resultant vector) occurred during the eyebrow lift expression, reaching 1.2 cm in magnitude. The mean maximum velocity (resultant vector), which ranged from 4.5 to 8.5 cm/s for the dynamic facial expressions, was greatest for the eyes closed tight expression. The mean maximum acceleration (resultant vector), which ranged from 193 to 465 cm/s/s, was greatest for the eyebrow lift expression. Symmetrical time plots were obtained. The system documented synkinesis by revealing substantial left upper eyelid motion during the nose-wrinkle expression in an illustrative case with slight left facial dysfunction. CONCLUSION: This approach to facial motion analysis is feasible for the simultaneous, multiregional, spatial-temporal assessment of facial expressions. Because motion at relatively remote regions could be quantified, this approach is potentially useful for the evaluation of synkinesis.     

Management of posterior ankyloglossia and upper lip ties in a tertiary otolaryngology outpatient clinic

ObjectivesRecent studies have shown an association between ankyloglossia (tongue tie) and upper-lip ties to breastfeeding difficulties. Treatment is commonly multidisciplinary involving lactation consultants and surgical management with tongue tie and upper lip tie release. There is currently limited data looking at posterior ankyloglossia and upper lip ties.MethodsConsecutive patients seen at an ENT outpatient clinic for ankyloglossia and upper-lip ties from May 2014–August 2015 were assessed for an outpatient frenotomy. Breastfeeding outcomes were assessed following the procedure.Results43 babies were seen and 34 patients had a procedure carried out. Babies ranged from 2 to 20 weeks old with the median age being 6.6 weeks. The most common presenting complaint was latching issues (85%) with mothers' painful nipples being the second (65%). 21 patients (62%) had a tongue tie release, 10 (29%) had both a tongue tie and upper lip tie divided, whereas 3 (9%) had an upper-lip tie alone divided. 29 (85%) of the patients who had a procedure carried out had an immediate improvement in breastfeeding, while 28 (82%) had a continued improvement at 2 weeks follow up.ConclusionsFrenotomy for posterior ankyloglossia and upper lip ties is a simple procedure that can be carried out in an outpatient setting with apparent immediate benefit. Otolaryngologists are likely to have an increasing role to play in the evaluation and management of ankyloglossia and upper lip ties in babies with breastfeeding difficulties.     

Three dimensional printing: A review on the utility within medicine and otolaryngology

Three dimensional (3D) printing is a novel technique that has evolved over the past 35 years and has the potential to revolutionize the field of medicine with its inherent advantages of customizability and the ability to create complex shapes with precision. It has been used extensively within the fields of orthopedics, dentistry, and craniofacial reconstruction with wide ranging utility including, medical modeling, surgical planning and the production of custom plates, screws and surgical guides. Furthermore, it has been used for similar means in the field of Otorhinolaryngology and also has potential to revolutionize the treatment of airway malacia. In fact, 3D printed external tracheal splints have already been studied in several pediatric patients with very promising results. The emerging field of 3D bioprinting, which integrates tissue engineering with 3D printing, may produce a paradigm shift with the potential introduction of customized functional biologic replacements.     

Grisel's syndrome in otolaryngology: a systematic review

AIMS: to assess etiology, treatment and outcome of Grisel's syndrome. METHODS: A Medline search was performed using the terms Grisel's syndrome, spontaneous atlantoaxial subluxation, head, neck, ear, nose and throat. A systematic review of the literature was performed. Case series of both adult and pediatric cases were included. Only papers focusing on true non-traumatic atlantoaxial subluxation were included. RESULTS: Seventy-one papers have been published from 1950 to 2006. Forty-eight of these fulfilled our inclusion criteria, totaling 103 patients for review. The main causes of Grisel's syndrome were infection (48%) and post-adenotonsillectomy (31%). Less common causes included other postoperative cases such as pharyngoplasty and ear operations. Neurosurgical consultation was paramount in all cases. In the majority of cases conservative management in the form of bedrest, antibiotics, muscle relaxants, traction and collar was effective; in a few cases only surgery in the form of arthrodesis was deemed necessary. Morbidity was significant in those cases where diagnosis was delayed, with the most devastating consequence a permanent neurological deficit in one case. CONCLUSIONS: Grisel's syndrome is a rare but dangerous complication that can go unnoticed in its early phase and can be a major cause of morbidity and mortality following infection or head and neck procedures/interventions. Early recognition of any cervical complication following routine otolaryngological operations together with early neurosurgical consultation is mandatory to prevent devastating consequences.     

Blastomycosis in otolaryngology: Review of a large series

Blastomycosis is a fungal disease whose signs, symptoms, and roentgenographs findings may suggest pneumonia, cancer, tuberculosis, or other fungal infections. Blastomycosis has a variable clinical course; it primarily affects the lower respiratory tract, although extrapulmonary manifestations are common. To determine the frequency of head and neck manifestations, we reviewed the records of patients with blastomycosis seen at the Mayo Clinic from 1960 to 1990 and found that involvement of the skin and mucosal surfaces, including the larynx, was common. Gross and histopathologic features of the lesions often resemble those of well-differentiated squamous cell carcinoma; thus, overly aggressive therapy may be mistakenly instituted. The clinical features, morphologic findings, and diagnosis of blastomycosis are discussed, and the importance of obtaining and handling specimens correctly is emphasized.     

Otogenic brain abscesses in a patient sample of the otolaryngology clinic of the Poznan Medical Academy 1953-1984

Between 1953-1984 we treated 64 otogenic brain abscesses (44 of the temporal lobe and 20 of the cerebellum). This material included 2 cerebral abscesses and 1 cerebellum abscess in children. In 3 cases the abscess was a complication of acute otitis media. 84% of patients with a temporal lobe abscess and 85% with a cerebellar abscess recovered. Treatment consisted of removal of the inflammatory process in the middle or inner ear with subsequent puncture of the abscess and replacement of the pus by antibiotic solution. Otologic, neurologic, ophthalmolgic, EEG and CT examinations were performed on 50 patients. Residual signs of epilepsy were found in 6 patients. Forty one patients resumed work or study. The merit of computer tomography (CT) in diagnosing brain abscesses is emphasized. Since CT has been used a successful outcome has been obtained in 8 cases and a fatal result in 1.