Clinical otolaryngology and allied sciences最新文献

In the period from 1977 to 1996 143 vestibular schwannomas were diagnosed in 138 patients in the County of Aarhus, Denmark. The natural history of vestibular schwannomas was observed in 50 patients with 52 tumours who did not undergo immediate surgical removal of their tumour due to small tumour size, advanced age, poor general health and the patients' refusal of surgery. The management included serial CT- or MR-imaging and complete otoneurological evaluation. The imaging interval was between 6 months and 2 years and depended on the recorded growth rate. Thirty-three (64%) of the tumours showed continuous growth with a mean growth rate of 1.6 mm/year. In 11 (21%) of the tumours the size was unchanged and eight (15%) remitted. The last group consisted mainly of the largest tumours. Among the tumours with positive growth, 15 (45%) had a growth rate of 1 mm/year or less. Generally, our findings showed that approximately two-thirds of all the tumours did not grow, were getting smaller or had a growth rate sufficiently small to be simply watched. Additionally, our results suggest that some symptomatic tumours will grow to a certain point whereupon stagnation or remission occurs.

Since the introduction and performance of total laryngectomy, voice restoration has become an important issue. Voice prostheses are widely used for this purpose. Based on experience with previous and current prostheses, the important characteristics for any voice prosthesis can be defined. These characteristics are: indwelling fixation, low resistance to airflow, less bothersome and easier insertion into the tracheoesophageal (TE) fistula. Also, predictable long device life span (resistance to Candida deterioration) and easy removal of the prosthesis to allow inspection or cleaning and consequent re-insertion are desirable. The VoiceMaster voice prosthesis was developed with these characteristics in mind. The VoiceMaster prosthesis is described in this paper. The first results from the preliminary study in which the currently available VoiceMaster was tested are very encouraging.

There is general agreement that the delivery of topical nasal medication by sprays is suboptimal. This study examines the distribution of spray to the anterior end of the middle turbinate as a guide to the distribution to the middle meatus by means of an endoscopic photographic comparison using dyed aqueous nasal spray. The technique was found to be reproducible. The effect of vigorously inhaling whilst spraying was studied by means of a randomized crossover trial and was found to have no significant effect. This technique could be used in conjunction with other means of assessing intranasal distribution when assessing improved topical nasal drug delivery systems.

Topical aminoglycoside ear drops are theoretically acknowledged to be potentially ototoxic when administered in the presence of a tympanic membrane perforation. Although the development of clinical ototoxicity appears to be rare, nine well-documented and incontrovertible cases (12 ears in total) of iatrogenic topical vestibulotoxicity are presented, representing the largest series in the English language world literature to date. All patients were treated with the topical gentamicin-containing ear drops Garasone, (betamethasone sodium phosphate and gentamicin sulphate) for prolonged periods. Toxicity was found to be primarily vestibular rather than cochlear. Further review of five previously reported cases in addition to the findings from another four patients identified with topical ototoxicity are described. Although compensation occurred in unilateral cases the disability in bilateral cases was typically severe and often resulted in litigation.

Forty-five patients diagnosed as having non-organic dysphonia were assigned in rotation to one of three groups. Patients in one group received no treatment and acted as a control group. Patients in the other two groups received a programme of either 'indirect' therapy or 'direct with indirect' therapy, respectively. A self-report questionnaire of vocal performance, observed ratings of voice quality, and computer-derived acoustic measurements (signal-to-noise ratio, pitch perturbation and amplitude perturbation) were carried out on all patients before and after treatment to evaluate the changes in voice quality over time. There was a significant difference between the three groups on the self-report questionnaire, voice quality ratings and pitch perturbation measurements (P = < 0.05). Thirteen out of 15 control patients showed no significant change on any of the measures. Seven patients who received indirect treatment showed significant improvement in voice quality following treatment. Fourteen out of 15 patients who received direct treatment showed significant improvement in voice quality.

Fifty-four surfers and 38 surf life savers were examined and questioned in order to determine the prevalence of exostoses. Seventy-three per cent had evidence of body exostoses in the external auditory meatus. Forty per cent had their ear canals narrowed by 50% or more. The relationship between the number of years spent surfing or life saving and the extent of canal stenosis was highly significant (P < 0.00001). Left and right ears were affected equally in this series and the obstruction appears to begin after approximately 7 years and is further aggravated by continued surfing. Over 90% of subjects who had participated for longer than 10 years had some evidence of exostoses. There was no significant association between the number of days per year or the number of hours per day spent surfing and the development of surfer's ear in this sample. Those who participated in their water sport over winter had significantly more exostoses than those who did not (P < 0.0001). Those who lived in the South Island (colder water) had more surfer's ear than those in the North Island (warmer water).

A structured quality of life questionnaire was developed as an instrument for the assessment of the functional, physical, psychosocial, and counselling problems in patients treated surgically for an oropharyngeal cancer. The questionnaire was tested in a pilot study in a relatively homogeneous group of 15 selected patients (all of whom had a comparable surgical defect, i.e. a composite resection of the oropharynx and neck, and had undergone an identical reconstruction method, i.e. a pedicled pectoralis major myocutaneous flap). All but two patients were irradiated as well. A high reliability (Crombach's alpha) was found in most of the applied subscales, indicating good internal consistency of the different questions. Significant correlations were found between several quality of life dimensions. The most frequently reported complaints concerned problems related to eating, speaking, and facial disfigurement. Problems with mastication, oral transport, and swallowing prohibited 11 patients returning to their normal diet. Regarding speech, 11 patients reported decreased intelligibility, in eight this was due to some degree of rhinolalia aperta. A significant association was found between moderate intelligibility and anxiety about speaking in public (P < 0.05). Eleven patients felt that the surgery had caused considerable facial disfigurement. For five of them this had a negative influence on their social interactions and activities outdoors. Thus, the consequences of the surgical treatment of oropharyngeal cancer can be assessed in a systematic and formal way with this specially designed structured questionnaire. Despite the small sample size, the selection of a homogeneous patient group appeared to give significant information, and to establish meaningful correlations.