Ceskoslovenska otolaryngologie最新文献

Duplex sonography not only provides the ENT specialist with valuable information on topographic relations of soft tissue tumours with the main blood vessels of the neck but provides also information on the blood flow in these vessels. It makes it possible to draw reliable conclusions on vascular anomalies or dislocation of the vessels, on affections of the vascular wall, on restricted patency of vessels due to the action of a tumour (compression, penetration) or inflammation (thrombus) or changes in the flow through the jugular vein conditioned by impaired passage in the S-shaped sinus. In some instance ultrasonic examination is a valuable method for evaluation of the dynamic and further development of the basic disease and can replace classical arteriography or phlebography.

The author describes a tonsillolith accidentally detected in a peritonsillar abscess in a 10-year-old girl. The concrement 26 x 4 mm in size, weighing 0.84 g was analyzed by infrared spectroscopy, X-ray diffraction which revealed that it was a dahllite. The surface of the concrement was documented by a scanning microscope. The authors give an account of 29 published cases of tonsilloliths and in the discussion they analyze the causes of development of these concrements in tonsils.

The authors analyzed 255 cases of occupational hypacusia reported as occupational diseases in 1962-1988 in the Czechoslovak uranium industry. Up to 1975 occupational hypacusias accounted for 9-11% of the nationwide number of hypacusia notified as occupational diseases. Due to extensive social provisions, incl. preventive ones, the incidence declined since 1985 below 1% of the nationwide incidence. The group of 255 men with occupational hypacusia was examined in detail at the Health Centre of the Uranium Industry in Príbam. Their age is 49.0 +/- 8.5 years, noise exposure 14.6 +/- 5.8 years, the the ratio of miners is 82.4%, the total percentage hearing loss is 63.5 +/- 11.4%, the mean annual increment of the total percentage hearing loss is 4.8 +/- 0.6%, the greatest mean annual increment is 5.4% in the occupation of miners.

The authors submit their experience with assessment of work capacity in Ménière's disease. They mention in particular work incapacity, detection of simulation and aggravation and discuss also the enlistment of work of these patients. They pay special attention to patients who drive cars. There is a different approach to amateur and professional drivers. Special attention is also devoted to the problem of granting full or partial invalid pensions. Their experience is based on a group of 300 of their own patients with Ménière's disease.

The authors investigated 325 children with acute laryngotracheitis. The frequency of the disease in 1986 was correlated with the three most frequent factors of atmospheric contamination, dust, sulphur dioxide and nitrogen oxides. The author found a significant increase of the morbidity from laryngotracheitis in conjunction with a greater contamination of the atmosphere.

The author describes rare chondromas of the paranasal sinuses in two female patients. In a younger woman a third relapse of chondroma in the olfactory labyrinth on the left was involved where the disease persisted for 31 years. The tumour spread to the orbit and intracranium and was therefore removed by frontal craniotomy. In the older patient the tumour grew cca 15 years. It blocked both nasal apertures and spread to all paranasal sinuses and the nasopharynx. It was removed from both sides, using the approach from right-sided lateral rhinotomy. It was not possible to locate exactly the site of origin in either patient. The tumours were benign and in the first case grew from the borderline between the ethmoid bone and the upper jaw. In the second patient most probably from the basophenoidal area. The author draws attention on the uncertain biological nature of chondromas at this site and the importance of total resection of the tumour during the first operation for the prognosis of the disease.

Dynamic ultrasonography is a diagnostic ultrasound examination which makes possible non-invasive visualization of soft tissue structures of the neck and its large blood vessels. Duplex ultrasonography makes moreover aimed assessment of the blood flow in major vessels possible and thus supplements in a significant way the echotomographic picture. Because of its non-invasive character it is preferable to CT and angiography in diagnostic work.

Densitographic examination of the regional pulmonary ventilation is a non-pretentious and non-invasive method which can be used even in very young children, which when aspiration of a non-contrasting foreign body is suspected can confirm by revealing localized bronchial obstruction the presence of a foreign body and determine its localization in the tracheobronchial tree. By repeated records of adequate ventilation at rest in all pulmonary fields it is possible with a minimal radiation load to rule out the suspicion and the child need not be subjected to an endoscopic examination. In five children aged 19 months to 13 years the usefulness of this procedure for the diagnosis of aspiration of a non-contrasting foreign body was proved, as the physical and skiagraphic finding was not convincing, there was discrepancy of anamnestic data and results of repeated skiagraphic examinations, negative auscultation and negative X-ray examination after an anamnestically obvious cse of aspiration, it ws used, for a more accurate localization of the aspired object, and to confirm localized obstruction of pulmonary ventilation in a chronic foreign body of plant origin in the airways. Foreign bodies of plant origin, most frequently aspired by children, are dangerous because they are fragile, swell and exert toxic action on the bronchial mucosa and there is also the danger of rapid development of serious bronchopulmonary complications. Therefore early diagnosis of aspiration is essential in these frequently obscure situations. When the direct skiagraphic signs of their presence in the lower airways are lacking dynamic pulmonary densitography contributes greatly to the diagnosis.

Based on the objective assessment of the threshold of the stirrup reflex, the author evaluated the inhibitory action of seven types of protective anti-noise devices. The results are summarized in a table.