Clinical medicine insights. Ear, nose and throat最新文献

Background: Cigarette smoke has been identified as the main cause of oral cavity carcinoma. Recently, the electronic cigarette, a battery-operated device, was developed to help smokers stop their tobacco addiction. This study aimed to evaluate the safety of electronic cigarettes and to establish the possible role of such device in the primary prevention of oral cavity cancer.

Subjects and methods: This study included 65 subjects who were divided into three groups (smokers, e-cigarette smokers, and nonsmokers). All subjects were submitted to cytologic examination by scraping of oral mucosa. The slides were microscopically evaluated through a micronucleus assay test.

Results: The prevalence of micronuclei was significantly decreased in the e-cigarette smoker group. There were no statistically significant differences in micronuclei distribution according to the type of cigarette, gender, and age.

Conclusions: The use of electronic cigarettes seems to be safe for oral cells and should be suggested as an aid to smoking cessation.

Objectives: To identify whether measurement of the prosthesis length is mandatory in patients requiring otosclerosis surgeries and to assess their postoperative audiometric outcomes. In addition, evaluation of prosthesis length used in revision compared to primary stapedectomy was carried out.

Study design: Case series with chart review.

Methods: Chart review of 393 patients undergoing primary (321) versus revision stapedectomy (72) was performed in a tertiary referral center. The indication for surgery was the presence or persistence/recurrence of an air-bone gap (ABG) greater than 20 dB. Air and bone conduction thresholds (ACT and BCT, respectively), ABG as well as pure tone averages (PTAs) were determined for all patients, and the results were compared preoperatively and postoperatively.

Results: Prosthesis length used ranged from 3.0 to 6.0 mm without differences between primary and revision groups. Of the revision surgeries, 62.5% were stapedectomies versus stapedotomies (P < 0.001). Patients showed significant decrease in speech discrimination score, with increased air and bone conduction thresholds as well as mean ABG and PTA before the revision surgeries as a first procedure failure. Prosthesis length changes occurred in 73.5% of the cases, with an average absolute change of 0.55 mm. Prosthesis length did not affect postoperative audiometric results between primary and revision groups, in all surgeries combined. When grouping stapes surgery into accurately versus inaccurately measured incus-footplate distance, significant differences were observed in prosthesis length employed (P < 0.01). Hearing outcomes were also better in the group in which an accurately measured prosthesis was chosen, as opposed to "standard-length" prosthesis.

Conclusions: This study corroborates postoperative success rates of revision surgeries, which show smaller improvements in hearing compared to a primary intervention. Accurate intra-operative measurement of prosthesis length was correlated with better audiometric results postoperatively.

We assessed the prevalence and predictors of malnutrition in patients with nasopharyngeal carcinoma. Sixty cases and 123 controls matched for age and gender were included. Bio-data, dietary history, height, weight, body mass index (BMI), ideal body weight, and serum albumin levels were recorded. Pretreatment weight loss of >5% was present in 35% of subjects (P < 0.0001). A BMI of < 18.5 kg/m(2) was present in 13.3% (P < 0.001), percent ideal body weight of <90% was present in 30% (P < 0.001), and serum albumin levels <30 g/dL was present in 23.3% (P < 0.001) of cases. Nasopharyngeal carcinoma increased the likelihood of having a BMI < 18.5 kg/m(2) (odds ratio, 9.3 (3.4-25.3) P ≤ 0.001). Logistic regression shows that stage IV disease was associated with a decrease in all parameters except protein-calorie intake. Stage IV nasopharyngeal carcinoma is a predictive marker for weight loss and low serum albumin levels. Nutritional management is important for ensuring the patients' ability to withstand chemoradiation and thus improve survival and quality of life.

Background: Antral irrigation earlier had an important role in the diagnosis and treatment of rhinosinusitis. Nowadays, it is often considered too unpleasant. However, the experience of patients of this procedure has been very seldom evaluated. Nor has the effect on pain in rhinosinusitis been evaluated. The aim of this study was to evaluate patients' experience of discomfort and pain during antral irrigation. We also assessed facial pain caused by rhinosinusitis before the procedure and pain soon after the procedure.

Methods: Doctors and 121 patients completed their questionnaires independently after antral irrigation in a university clinic, in a private hospital, and at a communal health center.

Results: Patients experienced mild pain during antral irrigation (mean and median visual analog scale score: <3). Their experience of pain during antral irrigation was closely comparable to pain during dental calculus scaling. Facial pain assessed before antral irrigation decreased quickly after the procedure.

Conclusions: Antral irrigation was well tolerated as an outpatient procedure. The procedure seems to relieve facial pain caused by the disease quickly. The role of antral irrigation in the treatment of acute rhinosinusitis will need further investigation.

Aims: Surgical treatment of nasal septal perforation remains a challenging field of rhinology. A large variety of techniques and grafts with promising results have been introduced for perforation repair. However, the use of fascia or fascia with periosteum has not been previously evaluated for a large sample of patients.

Methods: During the years 2007-2014, 105 operations were performed and 98 patients were treated for nasal septal perforation at the Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland. We performed a retrospective review of closure rates and complications. Follow-up time ranged from 1 to 62 months.

Results: Bleeding was the most common early complication (9%), followed by postoperative infection (5%) in the whole series. Our main technique, bipedicled advancement flaps with fascia or fascia and periosteum, was performed for 81 patients. We obtained successful closure in 78% of these patients with this operative technique and the rate increased to 86% during the last 3 years of the study period.

Conclusions: Perforation repair with temporal fascia or fascia with periosteum requiring only one donor site seems to be a reliable option for nasal septal perforation repair.

Objectives: To evaluate the effectiveness of selective neck dissection of sublevel IIa and level III in cases of glottis and supraglottic laryngeal carcinoma in the absence of lymph node metastasis and to show if there is value in dissecting the sublevel IIb or level IV in these cases.

Patients and methods: Twenty-five patients with N0 glottic or supraglottic cancer were subjected to unilateral or bilateral selective neck dissection according to the site and the extent of the tumor, and the specimens were histopathologically examined for metastasis.

Results: Twenty-five patients (23 males and 2 females) with mean age of 55.72 years were included in the study. Lymph node metastasis to sublevel IIa and level III was found in 6/25 (24%) cases with glottic or supraglottic carcinoma, while to sublevel IIb and level IV was found in 1/25 (4%) with P-value of 0.05, which is statistically significant.

Conclusion: Selective neck dissection of level IIb is not required in cases of the supraglottic laryngeal cancer. Dissection of sublevel IIa and level III takes less time and is effective. Dissection of level IV is not needed in the case of supraglottic cancer.

Background: Invasive fungal rhinosinusitis is an uncommon disease with high mortality rates. There is currently no consensus on the best treatment timing. We studied the impact of the treatment timing on the survival of patients experiencing invasive fungal rhinosinusitis.

Methods: We conducted a retrospective study of patients suffering from invasive fungal rhinosinusitis. The duration of symptoms, clinical presentations, clinical signs, diagnoses, treatments, and outcomes were collected.

Results: It was observed that more than 70% of the mortalities occurred within the subgroup of patients who exhibited symptoms of the disease within 14 days before admission. After adjusting for the confounders, the time taken to treat the patients was the most statistically significant predictor for mortality (P = 0.045). We found no significant relationships between mortality and its significant covariates, which included the underlying diseases (P = 0.91) or complications (P = 0.55).

Conclusions: Our study demonstrates that the time taken to treat the patients is an important determinant for the survival of patients who are afflicted with invasive fungal rhinosinusitis. The appropriate treatments should be administered within 14 days from the time the symptoms begin to manifest.

Background: In many centers, (18)F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) is used to monitor treatment response after definitive (chemo)radiotherapy [(C)RT] for head and neck squamous cell carcinoma (HNSCC), but its usefulness remains somewhat controversial. We aimed at assessing the accuracy of FDG-PET/CT in detecting residual disease after (C)RT.

Method: All HNSCC patients with FDG-PET/CT performed to assess treatment response 10-18 weeks after definitive (C)RT at our institution during 2008-2010 were included. The patient charts were reviewed for FDG-PET/CT findings, histopathologic findings, and follow-up data. The median follow-up time for FDG-PET/CT negative patients was 26 months.

Results: Eighty-eight eligible patients were identified. The stage distribution was as follows: I, n = 1; II, n = 15; III, n = 17; IV, n = 55. The negative predictive value, positive predictive value, specificity, sensitivity, and accuracy of FDG-PET/CT in detecting residual disease were 87%, 81%, 94%, 65%, and 85%, respectively. The corresponding specific figures for the primary tumor site were 91%, 71%, 94%, 59%, and 86% and for the neck 93%, 100%, 100%, 75%, and 94%, respectively.

Conclusions: In patients who have received definitive (C)RT for HNSCC, post-treatment FDG-PET/CT has good potential to guide clinical decision-making. Patients with negative scan can safely be followed up clinically only, while positive scan necessitates tissue biopsies or a neck dissection to rule out residual disease.

Objective: To compare the outcome and success of repair of uncomplicated tympanic membrane perforations with myringoplasty alone and when combined with mastoidectomy.

Methods: A prospective study where 40 patients with non-cholesteatomatous chronic suppurative otitis media (CSOM) were recruited during the period of June 2013 to December 2013 from the outpatient clinic of Otorhinolaryngology department, Faculty of medicine, Cairo University. Patients were managed medically and after dryness of their perforations they were operated upon. Twenty patients underwent simple myringoplasty alone and 20 patients underwent myringoplasty with cortical mastoidectomy. Underlay technique with temporalis fascia was done for all patients. Follow-up period was at least 3 months.

Results: Hearing improvement was comparable in both groups. There was no significant difference in graft uptake between the myringoplasty alone group (70%) and cortical mastoidectomy group (80%) (P = 0.7). There was no significant difference in ear dryness between the myringoplasty alone group (75%) and cortical mastoidectomy group (90%) (P = 0.4).

Conclusion: Mastoidectomy performed in non-cholesteatomatous CSOM in this study gives no statistically significant benefit over simple myringoplasty as regards graft success rate and dryness of the middle ear with comparable hearing outcome.

Background: Bilateral abductor vocal fold paralysis can lead to respiratory distress and dyspnea.

Objectives: To assess the efficacy of CO2 laser unilateral posterior cordotomy in cases with bilateral abductor paralysis as regards improvement of dyspnea with preservation of satisfactory voice and swallowing after the operation.

Methods: A prospective study was done on 18 patients with bilateral abductor vocal fold paralysis (10 females and 8 males) from November 2010 to December 2012 with their ages ranging from 32 to 64 years.

Results: All patients showed improvement of dyspnea after the operation, most of the patients suffered from mild to moderate dyspnea in the immediate post-operative period, and two patients needed another intervention to solve it. All the patients had satisfactory results of their voice after the operation, and one patient only suffered from temporary aspiration.

Conclusion: Unilateral CO2 laser posterior cordotomy is an easy and effective procedure to solve the dyspnea after bilateral vocal fold abductor paralysis without aspiration or significant voice alteration.