Assessment of common otolaryngological diseases among children in rural primary schools in south eastern Nigeria

ObjectivesDespite a global improvement in health care delivery, rural areas in developing countries still have poor access to specialist care. This study aims to assess the occurrences of ear, nose, and throat (ENT) disorders among rural primary school children in south-eastern Nigeria.MethodsTwo rural primary schools were selected randomly from one of the rural regions of South Eastern State of Nigeria. All the pupils of the schools who gave consent were recruited. A structured study proforma investigating the pupils' biodata, otolaryngological symptoms, ear, nose and throat examination findings, was used to evaluate each pupil in the presence of the teachers.ResultsA total of 246 children participated in the study. 145(58.9%) were males while 101(41.1%) were females with a mean age of 8.5 ± 2.4 years. The commonest symptoms reported were nasal discharge (20%) followed by nasal obstruction (11.1%), itching of the ears (11.1%) and sneezing bouts (10%), while 3.7% had subjective hearing impairment. The commonest ENT finding was cerumen auris (43%) and this was observed in 43.4% of males and 42.4% of females, 11% had abnormal tympanic membranes and 20% had grades 3/4 tonsils(Brodsky grading).ConclusionENT disorders are still common in children in the rural areas of developing countries. To avoid the morbidity associated with these preventable and easily manageable disorders, community health workers should be trained to manage common ENT disorders and mobile clinics with scheduled visits made available in areas where ENT services remain inaccessible.     

Food allergy. Diagnosis and treatment

The problem of food sensitivity causing chronic disorders of the ear, nose, and throat has been a known fact for many years. Diagnosis and management of the problem are well within the abilities of any concerned otolaryngologist. Precise means of laboratory diagnosis are currently being developed and should aid us in the treatment of this disorder.     

Prognostic factors for persistent otitis media with effusion in infants.

OBJECTIVE: To study prognostic factors for persistent otitis media with effusion (OME) in a birth cohort of 30,099 children born in the eastern part of The Netherlands between January 1, 1996, and April 1, 1997. DESIGN: Case-referent study. SUBJECTS: Children who failed a triple hearing test before their first birthday and were subsequently diagnosed with bilateral OME during 3 of the 4 bimonthly visits to an ear, nose, and throat (ENT) department (n = 372). The persistent cases were compared with 3 referent groups: (1) all the children who attended the first of 3 hearing tests; (2) all the children of the birth cohort who were referred to an ENT department after the third hearing test; and (3) all the children who were diagnosed with bilateral OME during the first visit to an ENT department. RESULTS: When all the children who participated in the first hearing test were taken as referents, persistent OME was associated with upper respiratory tract infections, attending a day-care center, having older siblings, and a family history of otitis media. When all the children who were referred to an ENT department were taken as referents, only attending a day-care center was associated with persistent OME. When the children diagnosed with bilateral OME during the first visit to an ENT department were taken as referents, no prognostic factors were found for OME persistence. CONCLUSION: When a child is referred early, an otolaryngologist can ask the parent about the presence of prognostic factors to decide which policy to follow.     

Dental otalgia

BACKGROUND: Secondary or referred otalgia can represent a diagnostic challenge to the otolaryngologist. Collectively, dental disorders are the most common causes of secondary otalgia presenting to the ENT clinic, and may account for up to 50 per cent of referred otalgia. Temporomandibular joint dysfunction syndrome represents the most common dental cause of referred otalgia. Decay and pulpal inflammation of posterior teeth can also frequently present as otalgia. The common embryological developmental origin of both oral and dental structures and the ear is responsible for their overlapping sensory nerve supplies, and this explains referred otalgia secondary to dental and temporomandibular joint disorders. These disorders can be easily overlooked, resulting in unnecessary and costly investigations. AIMS: This review aims to give a succinct overview of common dental causes of otalgia, and to provide ENT clinicians with guidelines for performing a rapid and simple dental and temporomandibular joint examination, which will reliably diagnose or exclude dental otalgia.     

Foreign bodies in the ear,nose, and throat in Japan: association with sociocultural and geographical conditions

ObjectiveForeign bodies (FBs) in ear, nose, and throat (ENT) are common ENT emergencies but are sometimes life-threatening. However, FBs could be avoidable by the efficient announcement about the risk of these occurrence to the public. Fish bones are commonly found as throat FBs, and small toys are commonly found as pediatric ear and nose FBs. We hypothesized that there were relationships between the occurrence of FBs and sociocultural/geographical conditions. The purpose of this study is to clarify the risk factors of FBs in ENT regions related to eating customs and weather conditions.MethodsFrom April 2009 to March 2014, 94,479 patients visited the Chuo Emergency Clinic (CEC) in Osaka, which is a local emergency center for Osaka prefecture in Japan. Among them, 3229 patients with throat FBs, 577 children (0–15 years of age) with ear FBs, and 1999 children (0–15 years of age) with nose FBs were enrolled into the present study. Monthly trends in the number of throat FBs were examined in relation to fish eating customs. The monthly average of the daily ratio of pediatric patients with ear or nose FBs to the total number of patients were examined in relation to weather parameters using a database of the Japan Meteorological Agency.ResultsThe incidence of throat FBs was significantly higher in July and January (p < 0.05, analyzed by ANOVA and Tukey–Kramer test), presumably because Japanese people have more chances to eat fish in these months due to the traditional fish-eating customs. There was also a significant correlation between the number of pediatric patients with ear and nose FBs and the bad weather parameters including daily rainfall (r = 0.76, p = 0.0043; r = 0.57, p = 0.050, respectively, analyzed by the Pearson product-moment correlation coefficient). This is because children would spend longer time inside on rainy days, which increases the chance of putting a small toy part in the ear and nose.ConclusionsFBs in throat and ear/nose occurred more frequently in the specific periods to eat fish and rainy days, respectively. Therefore, public announcement on the risk of occurrence of FBs based on sociocultural and geographical data is helpful to prevent FBs.     

Clinical evaluation of the electronic nose in the diagnosis of ear, nose and throat infection: a preliminary study

The term electronic nose describes an electronic system that is able to mimic the human sense of smell. Electronic noses have been developed over the last 10 or more years to perform a variety of identification tasks in various industries. More recently electronic noses have attracted new interest in their application in the field of medical diagnosis. The aim of this study is to explore the use of an electronic nose to identify and classify pathogens associated with ear, nose and throat (ENT) infections. In this study 90 bacterial swab samples were collected from 90 patients with ENT infections. Some of these samples were analysed immediately with a commercial electronic nose (Cyranose C320). Similar numbers of swabs were also taken from the same site of infection and were sent for microbiology culture and sensitivity. The electronic nose diagnosis was compared with the microbiology diagnosis and it was found that the electronic nose diagnosis was correct in 88.2 per cent of the cases, which is an encouraging result.     

Tauchtauglichkeit im HNO-Bereich

In line with the rising number of recreational divers, the otorhinolaryngologist has to deal with growing numbers of diving-associated disorders of the ear, nose and throat (ENT). Nevertheless, the majority of divers present to their ENT doctor for assessment of their fitness to dive. On the basis of long-term follow-up examinations and increasing experience in diving medicine, even divers with a history of ENT problems can be considered fit to dive. Therefore, diving is possible after tympanoplasty, surgery to improve hearing including stapesplasty, after implantation of middle ear amplifiers or cochlear implants, after sinus or scull base surgery and even after canal wall down mastoidectomy, provided that certain requirements are fulfilled. Assessing fitness to dive after inner ear barotrauma as well as after inner ear decompression illness requires meticulous consideration of residual damage and possible underlying conditions like vascular right-to-left shunts. This article is based on the new recommendations of the German Undersea and Hyperbaric Medical Society for the assessment of fitness to dive in the otorhinolaryngological field.     

ENT manifestation in COVID-19 patients

Objectiveto detect, analyze and discuss the different ear nose throat (ENT) manifestations those were reported in COVID19 positive patients in the reviewed and published literatures.MethodsWe performed a search in the PubMed databases, Web of Science, LILACS, MEDLINE, SciELO, and Cochrane Library using the keywords; COVID-19, Novel coronavirus, corona, 2019-nCoV, SARS-CoV-2, ENT, ear, nose, throat, otorhinolaryngology, ORL, pharynx, ORL, smell, larynx, different ENT related symptoms. We reviewed published and peer reviewed studies that reported the ENT manifestations in COVID-19 laboratory-confirmed positive patients.Resultswithin the included 1773 COVID-19 laboratory-confirmed positive patients, the most common ENT manifestations of COVID-19 were sore throat (11.3%) and headache (10.7%). While the other reported ENT manifestations were pharyngeal erythema (5.3%), nasal congestion (4.1%), runny nose or rhinorrhea (2.1%), upper respiratory tract infection (URTI) (1.9%), and tonsil enlargement (1.3%).ConclusionENT manifestations for COVID-19 are not common as fever and cough. But, a universal questionnaire using well-defined COVID-19 manifestations is needed to make the COVID-19 data precisely defined, complete and homogenous.     

Nasal injury management: an audit of accident and emergency practice

Nasal injuries are commonly assessed in the accident and emergency (A&E) departments. Where swelling precludes assessment of deformity, patients are often referred to the ear, nose and throat (ENT) outpatients once the swelling has subsided. However, not all of these pateints require referral. Patients with no deformity, or those in whom there is no deformity after any swelling has subsided, do not need further assessment. The purpose of this audit was to assess the impact of a nasal injury management guideline on nasal injury referrals to the ENT department. An audit was made of nasal injury referrals seen in ENT outpatients, before and after the introduction of a guideline. The proportion of patients seen in ENT outpatients not requiring any ENT treatment after the introduction of the guideline was reduced. We suggest that our guideline can reduce unnecessary ENT outpatient appointments for patients with nasal injuries and may prevent delayed ENT input for those with new onset nasal deformity.     

Rhinorrhea associated with intracranial cholesteatomas and an “empty sella”

Three related disorders in the same patient, namely bilateral primary intracranial cholesteatomas, an “empty sella” syndrome, and a cerebrospinal rhinorrhea are reported. No previous report of bilateral symmetrical cholesteatomas has been made, though single intracranial cholesteatomas have frequently been recorded in medical literature. The “empty sella” syndrome is generally considered to be from a herniation of the subarachnoid into the sella through a deficient diaphragma sella, and was first defined by Ommaya in 1968. Non-traumatic (spontaneous) rhinorrhea remains an uncommon disease initially described in 1826. Experience of the individual otolaryngologist is limited in this region because of infrequent occurrence and because definitive treatment is directed to other specialties. On the other hand, the ear, nose and throat physician may be the first to interpret a drainage from the nose. With this in mind, the etiologic, clinical and management factors in the present case are discussed.     

Foreign bodies of the nose and ears in children. Should these be managed in the accident and emergency setting?

OBJECTIVE: This study reviews the management of children with foreign bodies in the nose or ear in an attempt to see whether these children can be successfully managed in the Accident and Emergency (A & E) Department or whether they should be directly referred to the Otolaryngology service. METHODS: The records of all children with a foreign body in either the nose or ear who presented to the Accident and Emergency Department at The National Children's Hospital over a 2-year period were reviewed. RESULTS: 82 children presented with a foreign body in the nose and 53 (65%) were successfully managed in the A & E Department. In contrast, of the 58 children with a foreign body in the ear only 4 (7%) were successfully removed in the A & E Department. CONCLUSION: Most foreign bodies in the nose can be successfully removed in the Accident and Emergency Department. In contrast there is a high failure rate in removal of foreign bodies from the ear in the A & E Department and these should be referred directly to the ENT service.     

Management of aural foreign body: an evaluative study in 738 consecutive cases

OBJECTIVE: Foreign body in aural canal is a common ENT (ears, nose, and throat) emergency, although not always managed by an otolaryngologist. The purpose of this study is to evaluate the effectiveness of treatment of this emergent problem by medical personnel other than otolaryngologist. MATERIALS AND METHOD: A retrospective study in 738 consecutive cases with an internal control group was carried out at the Dr Ram Manohar Lohia Hospital, New Delhi, India, and the Institute of Medical Sciences, Banaras Hindu University, Varanasi, India, over a period of 2 years each. The methodology of removal and complications were tabulated and statistically analyzed using chi(2). RESULT: A complication rate of 77% and general anesthesia (GA) induction for removal in 10% of cases was seen in patients treated by other health care personnel, whereas a minimum complication rate of 19.5% and a GA induction in only 3.5% of cases were recorded in patients managed by otolaryngologist. CONCLUSION: The collected data, when put to statistical examination, clearly indicate that patients manipulated by medical personnel other than ENT surgeon have a much higher chance of complication and GA induction for removal of foreign body. This underlines the importance of strict otolaryngologist management in all cases.     

妊娠期耳鼻喉疾病孕妇临床护理分析

目的分析妊娠期耳鼻喉疾病孕妇临床护理方法其效果。方法回顾性我院收治的78例妊娠期耳鼻喉疾病孕妇参与本研究,按照护理方法的差异将其分为对照组与观察组,每组39例,对两组护理前后的心理状态进行比较。结果护理1个月后,观察组与对照组HAMD评分、HAMA评分均有所降低,但观察组降低幅度明显大于对照组(P<0.05)。结论对妊娠期耳鼻喉疾病孕妇实施综合护理,可以帮助其改善心理状态,促进孕妇身心健康。     

Ear, nose and throat manifestations of ectodermal dysplasia

This review of ectodermal dyplasias (ED) presents the particular syndromes that might present to the otolaryngologist for management and discusses the ear, nose and throat manifestations of the condition.     

Why should disorders of the ear, nose and throat be treated by the same specialty? Can this situation persist?

The surgical specialty of otorhinolaryngology has its origins in the nineteenth century. Subsequently, the specialty also incorporated allied disciplines such as plastics and head and neck surgery. Following World War II, the survival of the specialty was threatened by the advent of antibiotics and the rise of the general surgeon. Despite this, the specialty of ENT was strengthened by strong post-war leadership and robust training.Today, with ENT knowledge ever increasing, the subspecialties have again begun to subdivide. Specialisation brings improved efficiency and outcomes; however, there remains a great need for the ENT generalist. Not all cases require subspecialist attention, and the generalist remains the basis of competent emergency cover. The natural development of otorhinolaryngology has brought the invaluable synergistic knowledge required to comprehensively treat disorders of the ear, nose and throat, knowledge that must not be overlooked when shaping the future of the specialty.     

3D打印技术在耳鼻喉科住院医师规范化培训中的应用探索

目的 观察3D打印技术在耳鼻喉科住院医师规范化培训中应用的效果,探讨其应用的可行性及有效性。 方法 结合耳鼻喉科住院医师规范化培训教学大纲要求,运用3D打印技术制作仿真模型,应用于规范化培训理论教学中,并在此基础上进行手术指导,完成实践教学。 结果 3D打印模型有助于住院医师形成空间立体概念,短时间内理解并掌握复杂的解剖结构,有效提高其手术技能,缩短培养周期。 结论 3D 打印技术在耳鼻喉科住院医师规范化培训中具有良好的应用前景。     

Mucus physiopathology, update and new therapeutic tendencies

The knowledge of mucous secretions has advanced considerably with respect to their altered physiological properties in various ear, nose and throat disorders. We review the physicochemical properties of normal mucus and abnormal mucus present in the airways during sinusitis, otitis media with effusion, etc. We have adapted the mucoactive drugs classification to the up-to-date european situation, presenting a bibliographic review. We have attempted to reconcile the agreed findings in the literature with the most recent advances in research that have resulted in new therapeutic strategies for the treatment of pathological hypersecretion in the airways.     

Prenatal and neonatal prophylaxis in otorhinolaryngology

Congenital malformations and diseases in the region of the ear, nose, throat, larynx and lower respiratory tract, have their source in genetic disorders and exogenous noxious factors influencing the development of the embryo, fetus and newborn child.The authors discuss the possibilities of prophylaxis during pregnancy, the perinatal period and the first days of life.     

Ear, nose, and throat operations in the United States, 1979 to 1984

Using data from the National Center for Health Statistics for 1979 to 1984, I found a 5% decrease in total ear, nose, and throat (ENT) operations, the largest decline of any surgical specialty. For the same five-year period, the number of ENT surgeons increased 15%. In 1983, ENT surgeons performed 478 000 operations on tonsils and adenoids, an 18% decrease from the 1979 total (584 000). The removal of tonsils and adenoids is the eighth most common operation performed in the United States. The second most common ENT operation, nose repair and plastic operations (263 000), is the country's 14th most frequent operation. The 20 most common ENT operations constitute 87% of all ENT operations. In 1983, ENT operations represented 9% of all surgery in this country. These figures show that numbers of ENT surgical operations have decreased over the last five years, despite a constantly increasing number of ENT surgeons.