Ear Nose and Throat

Tuberculous otitis media can be difficult to diagnose because it can easily be confused with other acute or chronic middle ear conditions. Compounding this problem is the fact that physicians are generally unfamiliar with the typical features of tuberculous otitis media. Finally, the ...

Introduction: While there is an increasing demand for minimally invasive operative techniques in Ear, Nose and Throat surgery, these operations are difficult to learn for junior doctors and demanding to supervise for experienced surgeons. The motivation for this study was to overcome ...

OBJECTIVE: Jugular foramen tumors are rare cranial base lesions that present diagnostic and management difficulties. With the availability of new diagnostic procedures these tumors have been more precisely studied and questions of whether, when, and how these lesions should be treated often arise. Data from 106 consecutive patients surgically treated in the past 17 years were retrospectively analyzed to identify surgical outcomes. METHODS: The tumors were approached by a multidisciplinary team composed of neurosurgeons, ear, nose, and throat surgeons, and neuroradiologists. Hypervascular lesions were embolized 3 to 5 days before surgery. The same surgical technique was used to resect all tumors. The surgical defect was covered with vascularized myofascial flaps. The internal carotid artery was infiltrated in two patients, and a saphenous graft bypass was carried out before removal of the lesions. The facial nerve was reconstructed with nerve grafts (great auricular nerve) or XII/VII anastomosis in five cases. Postoperative radiotherapy was carried out for malignant and invasive tumors. RESULTS: Paragangliomas were the most frequent lesions, followed by schwannomas and meningiomas. Complete excision was possible in 89% of benign tumors and 80% of paragangliomas. Lower cranial nerve deficit was the most frequent complication (10 patients, 9.4%), transient in 4 patients. Facial and cochlear nerve paralysis occurred in 8 patients (7.5%). The function of the facial nerve recovered spontaneously in 3 patients. Four patients (3.7%) developed postoperative cerebrospinal fluid leakage. Four patients (3.7%) died after surgery. CONCLUSION: Radical removal of benign jugular foramen tumors is the treatment of choice and may be curative. Large lesions can be radically excised in one surgical procedure with preservation of lower cranial nerves. Cranial base reconstruction with vascularized myofascial flaps reduces the incidence of postoperative cerebrospinal fluid leakage. Damage of the lower cranial nerves is the most serious surgical complication.

To test the hypothesis that homoeopathy is a placebo by examining its effect in patients with allergic rhinitis and so contest the evidence from three previous trials in this series. Randomised, double blind, placebo controlled, parallel group, multicentre study. Four general practices and a hospital ear, nose, and throat outpatient department. 51 patients with perennial allergic rhinitis. Random assignment to an oral 30c homoeopathic preparation of principal inhalant allergen or to placebo. Changes from baseline in nasal inspiratory peak flow and symptom visual analogue scale score over third and fourth weeks after randomisation. Fifty patients completed the study. The homoeopathy group had a significant objective improvement in nasal airflow compared with the placebo group (mean difference 19.8 l/min, 95% confidence interval 10.4 to 29.1, P=0.0001). Both groups reported improvement in symptoms, with patients taking homoeopathy reporting more improvement in all but one of the centr...

Objective: To emphasize the benefits of tele-otology in community screening of patients with ear diseases. Methods: A retrospective study of all patients screened and treated under the Shruti tele-otology program between 2013 and 2019 was conducted. It involved screening, diagnosis, medical management, surgical intervention, and rehabilitation using hearing aid. The study focused on underprivileged and underserved community of rural and urban slums across 12 states of India. The study was conducted using a telemedicine device called ENTraview, that is, a camera-enabled android phone integrated with an otoscope and audiometry screening. Result: A total of 810 746 people were screened, and incidence of various ear diseases was recorded. Ear problems were found in 265 615 (33%) patients, of which 151 067 (57%) had impacted wax, 46 792(18%) had chronic suppurative otitis media, 27 875 (10%) had diminished hearing, 12 729 (5%) had acute otitis media and acute suppurative otitis media (AS...

We eondueted a prospeetive, randomized, double-blind, plaeebo-eontrolled, multieenterstudy to assess the effieaey ofehlorhexidineglueonate/benzydamine HCl mouth spray for redueingpain and improving quality of life in patients with aeute viral pharyngitis. Prior to treatment, patients rated the intensity of their pain on a visual analog seale and evaluated their quality of life on the 36-Item Short-Form Health Survey. Patients were then randomized to reeeive either paraeetamol (aeetaminophen) plus ehlorhexidine/ benzydamine or paracetamol plus plaeebo for 7 days. On days 3 and 7 of treatment, the partieipants again rated the intensity of their pain, and on day 7, they again rated their quality of life. A total ofl 64 patients were évaluable at study's end-80 in the ehlorhexidine/benzydamine group and 84 in the eontrol group. A eomparison of self-evaluations revealed that the aetive treatment group reported less pain on both day 3 (p < 0.001) and day 7 (p = 0.002). Likewise, the ehlorhexidine/benzydamine group reported a signifieantly better quality of life on day 7 (p < 0.001). ehlorhexidine/benzydamine was well tolerated, and no serious adverse events were observed.

Objective: The aim of the study was to assess different radiologic bony landmarks for endoscopic localization of the sphenopalatine foramen (SPF). Methods: Paranasal computed tomography (CT) scans of adults without sinonasal pathology were included. On axial cuts, the anteroposterior distances from the SPF to maxillary line, anterior head of the middle turbinate, basal lamella of the middle turbinate, choanal arch, and posterior fontanel of the maxillary sinus ostium were measured. While on coronal cuts, the vertical distances from the SPF to the nasal floor was measured. The registered measurements were then studied and statistically analyzed. Results: In 70 patients (140 sides, 840 measurements), the mean distances from the SPF to nasal floor, choanal arch, maxillary line, anterior head of the middle turbinate, basal lamella, and posterior fontanel were 25.6 AE 2.4, 8.5 AE 1.38, 36.4 AE 2.6, 34.6 AE 4.26, 8.1 AE 1.27, and 13.7 AE 1.7 mm, respectively, without significant differences between right and left sides. Females showed significantly shorter mean distances between SPF and the nasal floor (P ¼ 0.0011), choanal arch (P ¼ 0.0459), and posterior fontanel (P < 0.0001) than males. While no significant differences were detected between both sexes as regard distances from SPF to maxillary line (P ¼ 0.5579), anterior head of middle turbinate (P ¼ 0.8581), and basal lamella (P ¼ 0.0638). Conclusion: Preoperative CT can provide multiple easily detected, reliable, and simple bony landmarks that can help SPF endoscopic localization. Thus the authors recommend adding these measurements to the preoperative CT checklist for patients scheduled for sphenopalatine artery ligation and/or excision of vascular lesions.

Results: There were 317 pregnant mothers. Mean age that occur during pregnancy affect the ear nose and was30.3(±3.5) years. 84.8% were within 26-35 years. throat. The effect may be transient but sometimes can Over half of the pregnant women were in third a s s u m e p a t h o l o g i c a l l e v e l s ; r e s u l t i n g i n trimester of pregnancy59.9%. The prevalence of otorhinolarngological symptoms. These symptoms otorhinolaryngological manifestations in the study are often neglected by the primary care givers even was 55.5%, 30.6% in present and previous pregnancies when gravid mothers complain either due to respectively. The common ENT symptoms ignorance or assumption as part of pregnancy experienced were excessive ear itching 44(25.00%); process. Recognition and prompt referral to vertigo 32(18.2%), gastro-oesophageal reflux51 otorhinolaryngologists for multidisciplinary (29.0%); restless sleep due to nasal obstruction, intervention is the key to good outcome. This study 61(34.7%), hypersomnia 46(26.1%). highlights otorhinolaryngological diseases pregnancy in a bid to improve knowledge and Conclusion: Otorhinolaryngological symptoms are Medicare for both practitioners and pregnant problems to gravid mothers but are often neglected. mothers. Early recognition of symptoms by their primary physician and prompt referral will promote multi-Methods: This was a cross-sectional descriptive disciplinary approach and better pregnancy outcome. survey in a nested hospital-based study in the University of Benin Teaching Hospital, Benin City. Keywords: Otorhinolaryngology, Physiology, Data was collected from a semi-structured hormone, Pregnancy, vertigo. questionnaire in a stratified sample population from January 2015-December 2016. Data was analysed using statistical package for social sciences version 16.0.

The arrival of a commercial surgical robotic platform at our institution has raised the question of its application and usefulness within the department of otolaryngology head and neck surgery. In order to answer this question, we sought to perform a qualitative review to examine the evolution of commercial surgical robotics and examine present and future applications of this emerging technology within our specialty. The main objective of this study is to examine the development and application of robotic surgery in otolaryngology, head and neck surgery. The study includes a qualitative systematic review. We have reviewed research papers and studies that speciWcally relate to the use of robots in otorhinolaryngology. More speciWcally, we have attempted to review those studies that have signiWcantly added to the development of this Weld. In summary, we have examined eight animal studies, six cadaveric studies, nine human trials. Robotic surgery in ENT is a safe and feasible option. In certain procedures, it oVers signiWcant beneWts over conventional surgery. Instrument and robotic arm size, and costs are limiting factors that prevent the use of robots being applied to many additional ENT procedures. We feel the development of new speciality-speciWc robots will yield a new era in the common use of robotics in ENT.

A 53-year-old nonsmoking man was evaluated for a troublesome dry cough of 5 months' duration. The coughing worsened when he was lying supine and was relieved when he was in an upright position. His medical history was unremarkable. A pulmonary evaluation did not reveal the cause.

Rinitis Vasomotor adalah penyakit yang tidak diketahui penyebabnya secara umum sepanjang sejarah. Rinitis vasomotor dapat terjadi setelah peningkatan berat badan, trauma kepala, sinusitis berat, kehamilan atau stres berat. Biasanya dikaitkan dengan hilangnya kontrol ataupun fungsi pembau hidung. Hidung yang sehat akan membengkak dan mengeluarkan cairan sebagai respons terhadap udara yang kotor atau sangat dingin. Pada rinitis vasomotor, hidung membengkak dan mengeluarkan lendir dan cairan menjadi iritasi ringan. Hidung yang berair, sumbat, dan terdapat sekret adalah keluhan yang biasa. Pemicu yang mengiritasi dapat meliputi asap, debu, bau alkohol, bahan kimia, angin atau kipas yang berhembus pada wajah, cepat kedinginan atau pemanasan tubuh, kertas koran, dan parfum. Hal ini dapat muncul dengan hidung berair yang banyak atau sumbat pada hidung dalam kaitannya dengan makan makanan panas atau pedas. Berbaring meningkatkan hidung tersumbat, sebaliknya, olahraga dapat membalikkan hidung yang tersumbat secara sementara. Tujuh puluh persen kasus rinitis vasomotor terjadi setelah usia 20 tahun, berbeda dengan rinitis alergi yang biasanya terjadi sebelum usia 20 tahun. Mayoritas penderita rinitis vasomotr adalah perempuan, dengan dominasi yang dilaporkan antara 55 sampai 71 persen.

A 22-year-old man was admitted with complaints of dyspnea and hoarseness. Laryngoscopy and computed tomography of the neck revealed a 1.5 x 2-cm solid mass obstructing the trachea. The black, pedunculated mass was completely removed through a tracheal incision, and a paratracheal lymph node dissection was performed. Histopathologic examination revealed nodular-type mucosal malignant melanoma. Cranial and thoracic computed tomography, abdominal ultrasonography, and histopathologic examination of the paratracheal lymph nodes showed no metastases. No recurrence has been noted in more than 3 years of follow-up.

Parotid fistula represents an uncommon complication in parotid surgery. Its early recognition contributes to successful management. The condition is distressing for both the patient and the surgeon, since conservative and operative treatment frequently fail. There is no consensus on the optimal management of parotid gland fistula. The aim of this study is to describe a new, simple procedure in the treatment of this condition using transdermal scopolamine. We report 3 cases of salivary fistulae occurring after parotidectomy. The patients were admitted to our department with swelling in the parotid region and an output of clear drainage from the drain site during oral intake. The patients were treated with a scopolamine transdermal release system applied to hairless skin overlying the parotid region. A prompt and remarkable decrease in daily salivary output was observed. Fistulae healed completely within 3 days. No collateral effects were observed. Parotid fistulae do not generally oc...

OBJECTIVE: Jugular foramen tumors are rare cranial base lesions that present diagnostic and management difficulties. With the availability of new diagnostic procedures these tumors have been more precisely studied and questions of whether, when, and how these lesions should be treated often arise. Data from 106 consecutive patients surgically treated in the past 17 years were retrospectively analyzed to identify surgical outcomes. METHODS: The tumors were approached by a multidisciplinary team composed of neurosurgeons, ear, nose, and throat surgeons, and neuroradiologists. Hypervascular lesions were embolized 3 to 5 days before surgery. The same surgical technique was used to resect all tumors. The surgical defect was covered with vascularized myofascial flaps. The internal carotid artery was infiltrated in two patients, and a saphenous graft bypass was carried out before removal of the lesions. The facial nerve was reconstructed with nerve grafts (great auricular nerve) or XII/VII anastomosis in five cases. Postoperative radiotherapy was carried out for malignant and invasive tumors. RESULTS: Paragangliomas were the most frequent lesions, followed by schwannomas and meningiomas. Complete excision was possible in 89% of benign tumors and 80% of paragangliomas. Lower cranial nerve deficit was the most frequent complication (10 patients, 9.4%), transient in 4 patients. Facial and cochlear nerve paralysis occurred in 8 patients (7.5%). The function of the facial nerve recovered spontaneously in 3 patients. Four patients (3.7%) developed postoperative cerebrospinal fluid leakage. Four patients (3.7%) died after surgery. CONCLUSION: Radical removal of benign jugular foramen tumors is the treatment of choice and may be curative. Large lesions can be radically excised in one surgical procedure with preservation of lower cranial nerves. Cranial base reconstruction with vascularized myofascial flaps reduces the incidence of postoperative cerebrospinal fluid leakage. Damage of the lower cranial nerves is the most serious surgical complication.

Gastroesophageal reflux disease (GERD) is the most common esophageal disorder and perhaps among the most prevalent conditions seen in the primary care setting. The clinical manifestations of GERD, typical or atypical, such as noncardiac chest pain, respiratory or ear, nose, and throat symptoms, result from the reflux of gastric contents into the esophagus. Thus the clinical spectrum is wide and requires accurate diagnosis. Ambulatory 24-hr esophageal pH monitoring is not useful in all patients suspected to have GERD. This review describes the technique of ambulatory 24-hr esophageal pH monitoring, the interpretation of findings, and clinical applications of this test.

Background The endoscopic endonasal transsphenoidal approach (EETA) to the pituitary is performed by ear, nose, and throat (ENT) surgeons in collaboration with neurosurgeons but also by neurosurgeons alone even though neurosurgeons have not been trained in rhinological surgery. Purpose To register the frequency of endonasal anatomical variations and to evaluate whether these variations hinder the progress of EETA and require extra rhinological surgical skills. Methods A prospective cohort study of 185 consecutive patients receiving an EETA through a binostril approach was performed. All anatomical endonasal variations were noted and the relevance for the progress of surgery evaluated. Results In 48% of patients, anatomical variations were recognized, the majority of which were spinae septi and septum deviations. In 5% of patients, the planned binostril approach had to be converted into a mononostril approach; whereas in 18% of patients with an anatomical variation, a correction had to be performed. There was no difference between the ENT surgeon and the neurosurgeon performing the approach. Complications related to the endonasal phase of the surgery occurred in 3.8%. Fluoroscopy or electro-magnetic navigation has been used during 6.5% of the surgeries. Conclusion Although endonasal anatomical variations are frequent, they do not pose a relevant obstacle for EETA.

Purpose: To know the otoneurologic profile of seniors&#x27; po- pulation, with and without complaints of vertigo, assisted in the Clinic of Fonoaudiology of Methodist University of Piracicaba (UNIMEP), in the period of August/2001 to July/2002. Method: Ear, nose and throat evaluation, audiogram and vestibular exams were accomplished in individuals that attended the clinic in the refered period. There were 36 individuals invol- ved in the research, age ranged from 60 to 90 years, with or without complaint of vertigo. Results: Vestibular disorders were found in exams of 50% of the seniors with complaint and in 50% of the seniors without complaint of vertigo. These disorders were mainly characterized by irritative vestibular syndrome (41,6%) in the two appraised groups. Conclusion: Labyrinthine disturbances are an important problem of senior population, because balance dysequilibrium disables elderly quality of life.

Amyloidosis of the ear is rare. We describe the case of a 41-year-old man who had localized amyloidosis that involved the external auditory canal and middle ear. To the best of our knowledge, only 4 other cases of amyloidosis involving the external auditory canal have been previously reported; in none of these cases was the middle ear involved. We also discuss the clinical importance of this condition and its treatment.

In what follows I will descend in the deeper artistic, cultural and anthropological layers that connect the Johannesschüssel with the objectification of the ‘abject’, with the obscenity of the apotropaion, with the Medusa effect and finally also with the ‘horror’ of uterine phantasms in the archetypes of decapitation and throat.
In fact, the original meaning of the term obscenitas goes beyond today's interpretation of the word ‒ immoral, dirty, scabrous with a strong sexual connotation ‒, and includes a wider realm that connects the obscene with gazing at something dirty, such as the genitals or the so-called cruor: the shedding of raw blood in the ritual of sacrifice.  Besides its relationship with the 'visual shock' of sex and blood, obscenitas encompasses in a more popular etymology obs+cano: what sounds, what is prophecy. A variant of this etymology is obsc(a)enitas as obscaevo (ob+scaevos): giving somebody an unfavorable omen.  These more complex semantics of obscenity touch indeed the functions of the Johannesschüssel during the Middle Ages and Early Modernity.

Aims To evaluate the antiemetic efficacy of ondansetron, metoclopramide or small dose of propofol following ear, nose and throat (ENT) surgery. Materials and methods A prospective randomized study involving 60 patients, both children and adults undergoing elective ENT surgery under standard general anesthesia. At the completion of surgery the patients received either 0.1 mg/kg of ondansetron or 0.2 mg/kg of metoclopramide or 0.5 mg/kg of propofol intravenously. The patients were observed for 24 hrs after operation for any occurrence of nausea and vomiting. Results The incidence of postoperative nausea and vomiting (PONV) during first 24 hrs was recorded in 20%, 70%, 50% of patients who had received ondansetron, metoclopr-amide or propofol respectively (p PONV was higher following middle year surgery. Conclusion It was concluded that ondansetron was most effective in preventing occurrence of PONV while metoclopramide was least effective. Propofol was effective only in 50% of patients, thus not recommended for routine use.

The objective of this research is to study the pattern of antimicrobial prescription in outpatient (OPD)
and inpatient (IPD) of the Department of Otolaryngology in a tertiary care teaching hospital of North  India. This was a prospective study conducted at the Teerthanker Mahaveer Medical College and  Research Centre, over a period of 12 months. All the patients who attended the Ear Nose and Throat  (ENT) OPD and IPD were included. The results show that out of 4800 patients, only 54% (n=2600) of  patients were included in the study on the basis of inclusion and exclusion criteria and 31.25 %  (n=1500) were defaulters. Majority of the patients were male 60% (n = 1560). Majority of the patients had  suffered from ear disorders, 55% (n=1430). The most frequently prescribed antibacterials were  β- Lactams (75.68%) followed by aminoglycosides (9.43%). Among the penicillin group, the commonest  drug prescribed was a combination of amoxicillin and clavulanic acid (9.58%), in cephalosporins was  cefixime (37.98%) and in aminoglycosides was gentamicin (6.25%). In the concomitant medications  antihistaminic were prescribed in 11.53%, proton pump inhibitors in 20.38% cases and NSAIDS in 7.26%  cases. The average number of drugs used in each prescription was 2.70. All the drugs were prescribed  with trade names. The average cost per prescription per day in OPD and IPD patients were Rs.45 and  Rs.185, respectively. Out of 2600 patients; culture sensitivity tests were performed for only 71 patients  (inclusive of OPD and IPD). Of which only 43 patients depicted a positive culture sensitivity tests. Our  study showed that antimicrobials were mostly prescribed in patients of ear diseases while it was least in throat disorders. Proton pump inhibitors were the most common concomitant drug used. The cost of  treatment in IPD patients were 4.11 times more than the OPD patients.

An increased awareness of biofilms and their mechanisms has led to a better understanding of bacterial infections that occur following the placement of tracheostomy tubes and other implanted devices and prostheses. One aspect of biofilm formation that is still subject to debate is whether the specific material that is used to manufacture a tube has any bearing in the incidence of infection. We conducted a test of four different tube materials--polyvinyl chloride, silicone, stainless steel, and sterling silver--to ascertain how bacterial biofilms form on tracheostomy tubes and to determine if there is a material-dependent difference in biofilm formation. Scanning electron microscopy demonstrated that Pseudomonas aeruginosa and Staphylococcus epidermidis both formed bacterial biofilms on tracheostomy tubes in vitro. We also found that there was no difference in susceptibility to biofilm formation among the four tube materials tested.

Vocal fold scar is one of the most challenging voice problems that face laryngologists because of the severe communication disorder associated with the pathology and the difficulty in facilitating the rehabilitation of the dysphonia.' Patients with a voice disorder caused by vocal fold scar require a holistic, multidimensional treatment approach. Patients with dysphonia secondary to vocal fold scar often demonstrate an associated compensatory muscle tension dysphonia. In addition, these patients usually have social, functional, and occupational issues that must be thoroughly explored and addressed. Given the complexity of dysphonia associated with vocal fold scar, nonsurgical and surgical rehabilitation methods usually are required to improve or resolve the dysphonia. For this reason, a comprehensive evaluation and treatment by a voice care team is warranted.

Carcinoma of an unknown primary (CUP) encompasses a heterogeneous group of tumors for which no primary site can be detected following a thorough history, physical examination, and noninvasive and invasive testing. CUP presenting with metastasis to the neck (metastatic cervical carcinoma from an unknown primary [MCCUP]) has been an enigma since von Volkmann first described it in 1882 as a cancer arising in a branchial cleft cyst. Genetic studies have shed some light on this unusual entity. In most cases, clinical features, imaging studies, and a meticulous assessment of the upper aerodigestive tract should assist in identifying the source of disease. Molecular testing of cytologic specimens for Epstein-Barr virus and human papillomavirus (HPV) can facilitate identification of the primary site in the nasopharynx and oropharynx. At least 25% of MCCUPs are directly attributable to HPV-related malignancies, and this number can be expected to increase. Minimally invasive transoral mucosal...

We conducted a prospective, randomized, double-blind, placebo-controlled, multicenter study to assess the efficacy of chlorhexidine gluconate/benzydamine HCl mouth spray for reducing pain and improving quality of life in patients with acute viral pharyngitis. Prior to treatment, patients rated the intensity of their pain on a visual analog scale and evaluated their quality of life on the 36-Item Short-Form Health Survey. Patients were then randomized to receive either paracetamol (acetaminophen) plus chlorhexidine/benzydamine or paracetamol plus placebo for 7 days. On days 3 and 7 of treatment, the participants again rated the intensity of their pain, and on day 7, they again rated their quality of life. A total of 164 patients were evaluable at study&#39;s end-80 in the chlorhexidine/benzydamine group and 84 in the control group. A comparison of self-evaluations revealed that the active treatment group reported less pain on both day 3 (p &lt; 0.001) and day 7 (p = 0.002). Likewise,...

A 42-year-old man was referred for a week history of severe dysphagia, odynophagia, fever (39 °C), fatigue, abdominal pain, pharyngeal swelling, and multiple neck lymphadenopathies. The medical history reported a mild form of COVID-19 one month ago. The biology reported an unspecified inflammatory syndrome. The patient developed peritonitis, myocarditis, and hepatitis. A myocardium biopsy was performed. A diagnosis of Kawasaki-like disease (KLD) was performed. The occurrence of KLD in adults is rare but has to be known by otolaryngologists regarding the otolaryngological clinical presentation that may precede the multiple organ failure.