Clinical otolaryngology and allied sciences最新文献

Possum (the physiological and operative severity score for the enumeration of mortality) is used in many surgical specialities for comparative audit. We investigated its validity in relation to head and neck surgery by retrospectively scoring 301 operative interventions. We also applied the P-Possum (Portsmouth Possum) equation for mortality. We compared our observed with the predicted outcomes. We introduced two new variables, radiotherapy and previous surgery to the operative site, to test their association with outcome. We found that Possum is valid for morbidity but predicts more accurately for high-risk than for low-risk groups. Neither Possum or P-Possum accurately predicts mortality. Radiotherapy and previous surgery were both significant for the development of postoperative complications (P = 0.002, P = 0.007 respectively) and are worthy of inclusion in a Possum score for head and neck surgery.

The purpose of this study was to investigate selective vestibular ototoxicity of gentamicin and streptomycin in the chinchilla model. In total, 10 chinchillas underwent left middle ear instillation of one of three agents: gentamicin, streptomycin and saline. Electrophysiological data (otoacoustic emissions (OAEs), auditory brainstem evoked response (ABRs), and ice-water electronystagmography were recorded before and after instillation. Animals were sacrificed for temporal bone studies using scanning electron microscopy. Morphological changes in the cochlear and vestibular neuroepithelia were correlated with electrophysiological changes. Widespread ipsilateral cochlear and vestibular neuroepithelial injuries were observed and correlated with loss of OAEs, ABRs and ice-water caloric response. This study provides no evidence of selective vestibular ototoxicity of gentamicin or streptomycin. Morphological damage correlates with, but precedes loss of electrophysiological parameters. Chinchillas, like other small mammals, may not be an ideal model for the study of human ototoxicity.

The purpose of this study is to present our experience with 34 patients diagnosed with juvenile nasopharyngeal angiofibromas and treated in the Chinese PLA General Hospital between 1986 and 1999, and to examine the factors influencing intra-operative bleeding and tumour recurrence. The age of the patient, the duration of symptoms and tumour stage were related to the amount of intra-operative bleeding. The tumours were totally resected in 30 patients and recurred in five patients (16.7%), with a mean follow-up time of 77 months. The mean time to tumour recurrence after operation was 3.2 months (1-6 months). The incidence of recurrence had no correlation with the age of the patient, duration of symptoms, peri-operative treatment or surgical approaches (P > 0.05); but strongly correlated with tumour stage (P < 0.05).

Benefit and satisfaction following endoscopic sinus surgery were assessed using the Glasgow Benefit Inventory (GBI) and a validated outcome satisfaction score. In total, 140 patients were invited to participate; 101 (71%) responded. ESS produces significant benefit as assessed by the GBI and satisfaction, and the benefit compares favourably with other otorhinolaryngological procedures. Greatest benefit was derived by patients undergoing surgery for polyp disease. Patients whose cardinal preoperative symptom was nasal obstruction or headache tended to report higher benefit. Co-existent asthma, allergic rhinitis or aspirin intolerance appeared not to result in a significant decrease in benefit after surgery, except in patients with non-polyp disease, who also have both aspirin intolerance and asthma. Also, for non-polyp disease, postoperative medication with nasal steroids or antihistamines does not appear to influence benefit.

The objective was to evaluate the necessity to use topical nasal anaesthesia before flexible nasendoscopy and to compare its use with placebo. The study was carried out using a double-blind randomized controlled trial, with three treatment arms, at the out-patient department at Raigmore Hospital, Inverness. The participants were 90 patients attending the otolaryngology out-patient department who required flexible nasendoscopy as part of their assessment. Each participant was randomized to one of three groups. Group 1 received cophenylcaine spray, group 2 received a placebo spray, and group 3 received no nasal preparation. Flexible nasendoscopy was carried out via a stated protocol and the patient's diagnosis and findings were discussed in the usual way. After the consultation, the patient filled in a questionnaire marking answers on a visual analogue scale. The main outcome measures were pain and overall unpleasantness of procedure. Patient anxiety and willingness to be examined again in the same way if necessary were also assessed. Ease of examination and quality of view were asked from the operator's perspective. The mean scores on a visual analogue scale showed the main outcome measures to be as follows. Pain score measured 1.7 for cophenylcaine, 2.1 for no spray and 2.2 for placebo. Overall unpleasantness scores were 2.0 for cophenylcaine, 1.9 for no spray and 2.4 for placebo. On a visual analogue scale of 0-10, none of these mean main outcome measures reached levels of significance. It was concluded that the use of cophenylcaine spray before flexible nasendoscopy does not give significant advantages over the use of no nasal preparation.

The aim of this study was to find out whether patients attending ENT clinics obtain health information about their medical condition and to assess satisfaction with the sources of health information, including the internet. Three hundred and thirty patients attending ENT outpatient clinics at District General Hospitals in Wigan and Warrington during June 2001 were asked to complete detailed questionnaires. Fifty-seven per cent of patients attempted to obtain health information before their visit to the specialist clinic. Forty-five per cent of patients had access to the internet, but only 13% used it to obtain health information. General practitioners were the source of health information for 64%, but the NHS-Direct help line was only used by 16%. Patients also trusted the health information provided by their GPs the most. In the twenty-first century, patients turn to their GP as the main source of health information.

The time-course of the recovery of the hearing level after treatment in 90 patients with idiopathic sudden sensorineural hearing loss was examined. The improvement rate calculated relative to the hearing level of the opposite ear was investigated to estimate the hearing recovery. Follow-up audiograms were performed once per week for 1 month after treatment and once per month thereafter. There were two groups that differed with respect to the characteristics of hearing recovery. One group showed an improvement rate of over 50% at 1-2 weeks and a good improvement rate at 3 months after treatment. In the other group, the improvement rate did not reach 50% at 1-2 weeks, and the improvement rate was poor at 3 months after treatment. The patients with improvement rates of over 50% at 1-2 weeks had earlier initial visits and had mild hearing loss, whereas the patients with profound hearing loss had improvement rates under 50% and poor long-term prognosis. We conclude that the improvement rate at 1-2 weeks after treatment predicts the long-term prognosis for recovery of hearing level in patients with sudden sensorineural hearing loss.

We examined the long-term outcome for patients with idiopathic sudden sensorineural hearing loss (sudden deafness), including the incidence of recurrence of sudden deafness. The subjects were 1,798 individuals who came to Nagoya University hospital within 2 weeks of the onset of unilateral sudden deafness. Only 14 of the patients had a history of being diagnosed with sudden deafness. After their visit to our hospital, one patient had a recurrence in the ipsilateral ear and four patients experienced sudden deafness in the contralateral ear. We performed hearing examinations on 88 patients who revisited our hospital more than 10 years after unilateral sudden deafness. Of these patients, there was one with a recurrence in the ipsilateral ear and one with sudden deafness in the contralateral ear. Thus, in this series the recurrence of sudden deafness was rare.

Benign paroxysmal positional vertigo (BPPV) is a syndrome characterized by short-lived episodes of vertigo in association with rapid changes in head position. Current treatment approaches include rehabilitative exercises and physical manoeuvres including the Epley manouevre. Randomized clinical trials of the Epley manoeuvre were identified. Outcome measures that were considered include: frequency and severity of attacks of vertigo; proportion of patients improved by each intervention; and conversion of a 'positive' Dix-Hallpike test to a 'negative' Dix-Hallpike test. Patients who received the Epley manoeuvre were more likely to have complete resolution of their symptoms [odds ratio 4.92 (95% C.I. 1.84-13.16)], and more likely to convert from a positive to negative Dix-Hallpike test [odds ratio 5.67 (95% C.I. 2.21-14.56)]. There were no serious adverse effects of treatment. There is some evidence that the Epley manouevre is a safe effective treatment for posterior canal BPPV.

11Beta-hydroxysteroid dehydrogenase 1 (11beta-HSD1) has been identified as a major detoxification enzyme of one of the most potent tobacco smoke-derived carcinogens, NNK. If not metabolized by 11beta-HSD1, activation of NNK by cytochrome p450 mono-oxidase 2D6 (CYP2D6) results in an electrophile intermediate responsible for DNA damage. Interindividual variability in the expression of 11beta-HSD1 and CYP2D6 has been found to influence the susceptibility to lung cancer. The aim of this study was to compare 11beta-HSD1 mRNA expression and CYP2D6 metabolizer status in pharyngeal tissues of patients with oropharyngeal carcinoma and controls. In 20 patients with oropharyngeal cancer and 15 non-smoking controls, the 11beta-HSD1 mRNA expression was assessed with RT-PCR. The frequency of genetic polymorphisms of the CYP2D6 gene was assessed using RFLP. It was found that 11beta-HSD1 mRNA is expressed in human pharyngeal mucosa. It is upregulated in mucosa exposed to tobacco smoke. In tumour tissues, 11beta-HSD1 expression was significantly lower than in non-affected mucosa. The frequency distribution of CYP2D6 gene polymorphisms was similar in patients and controls. Chronic tobacco abuse results in 11beta-HSD1 enzyme induction. A reduction of 11beta-HSD1 expression in tumour tissues could be a consequence of malignantly transformed cells. It remains unclear if the lower 11beta-HSD1 expression gives rise to an increased rate of additional mutations.