RESUMEN
In the UK, stapes surgery is performed almost universally under general anaesthesia. In 1984 there was consensus that local anaesthesia should be the technique of choice in stapes surgery. Despite reports of successful use of local anaesthesia for middle ear surgery, this is still not widely accepted practice in the UK. We describe the senior author's technique for local anaesthetic stapes surgery and present the hearing results for a series of 100 consecutive cases.
Asunto(s)
Anestesia Local , Pérdida Auditiva/cirugía , Cirugía del Estribo/métodos , Procedimientos Quirúrgicos Ambulatorios/métodos , Audiometría/métodos , Humanos , Cuidados Posoperatorios/métodosAsunto(s)
Implantación Auditiva en el Tronco Encefálico/métodos , Implantación Coclear/métodos , Sordera/congénito , Sordera/cirugía , Nervio Vestibulococlear/anomalías , Adolescente , Factores de Edad , Implantación Auditiva en el Tronco Encefálico/efectos adversos , Umbral Auditivo , Niño , Preescolar , Implantación Coclear/efectos adversos , Implantes Cocleares , Estudios Transversales , Sordera/diagnóstico , Femenino , Estudios de Seguimiento , Pérdida Auditiva Central/congénito , Pérdida Auditiva Central/diagnóstico , Pérdida Auditiva Central/cirugía , Humanos , Lactante , Percepción Sonora/fisiología , Imagen por Resonancia Magnética/métodos , Masculino , Complicaciones Posoperatorias/fisiopatología , Cuidados Preoperatorios/métodos , Valores de Referencia , Sistema de Registros , Medición de Riesgo , Percepción del Habla/fisiología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Nervio Vestibulococlear/patologíaRESUMEN
The objective of the study was to determine risk factors for late skin flap failure following cochlear implantation. The study design was a retrospective case series. Data were collated from 371 implanted patients over a ten-year period. Of these patients, 1.3 per cent (n = 5) developed late skin flap failure. It is concluded that skin flap failure is a significant, though relatively uncommon, complication of cochlear implant surgery. What causes flap failure and why it should occur in such a variable fashion are still largely unknown, though infection undoubtedly plays an important role. The aetiological factors associated with flap failure and possible prevention strategies are discussed.
Asunto(s)
Implantación Coclear/estadística & datos numéricos , Anciano , Cefalosporinas/uso terapéutico , Cóclea/diagnóstico por imagen , Cóclea/fisiopatología , Cóclea/cirugía , Humanos , Masculino , Reoperación , Estudios Retrospectivos , Colgajos Quirúrgicos , Infección de la Herida Quirúrgica/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Insuficiencia del TratamientoRESUMEN
The otolaryngologist plays an essential role in the diagnosis and management of a facial palsy. We present one of the largest cohort prospective studies in the UK of 22 patients with gold weight implants, including ancillary oculoplastic techniques, and their outcomes. Facial paralysis places the eye at risk and protection and lubrication of the eye is paramount in the management of these patients. If recovery of facial function is likely to be delayed or negligible, gold weight loading of the upper lid has been shown to be effective in providing a dynamic solution to lagophthalmos. Following surgery, complete eye closure was possible in the upright position in 18 patients (82%). Two patients had their weights removed secondary to infection (9%). At long-term follow up, four patients judged their vision to have deteriorated (29%). Two of these, after investigation by the ophthalmologists, were found to have pressure astigmatism and removal corrected the visual problems. Overall patient satisfaction with the procedure is high and all reported improvement in eye closure following the operation. An algorithm for the management of the eye in patients with facial palsy is outlined.
Asunto(s)
Enfermedades de los Párpados/terapia , Párpados/cirugía , Parálisis Facial/complicaciones , Oro , Prótesis e Implantes , Estudios de Cohortes , Enfermedades de los Párpados/etiología , Parálisis Facial/terapia , Estudios de Seguimiento , Humanos , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Helicobacter pylori is an accepted cause of chronic active gastritis and has a major causative role in peptic ulceration. It is a gastric carcinogen. Its role in non-ulcer dyspepsia (NUD) is less clear; yet 50 per cent of patients with NUD are infected with H pylori. H pylori has been investigated in several other organ systems, but has not been investigated extensively in squamous cell carcinoma of the upper aerodigestive tract, a region which could be directly exposed to the bacterium by gastro-oesophageal reflux (GOR). In this study 61 patients with severe laryngeal dysplasia or frank carcinoma of the head and neck are striated by age, investigated for the presence of antibodies to H pylori and compared to age and sex matched controls. In the age group of 46-61 years, the presence of H pylori antibodies was marginally greater in the experimental (63.0 per cent) than the control group (40.7 per cent) (Pearson Chi square p = 0.055, Fisher 2-sided exact test p = 0.066). When combining this age group with the younger age group and thereby creating two roughly equal groups (n = 31 and n = 30) there was also a statistical trend towards increased positivity in the experimental group. These findings are discussed in the light of other studies with gastro-oesophageal reflux disease (GORD).
Asunto(s)
Carcinoma de Células Escamosas/microbiología , Neoplasias de Cabeza y Cuello/microbiología , Infecciones por Helicobacter/complicaciones , Helicobacter pylori/aislamiento & purificación , Lesiones Precancerosas/microbiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Ensayo de Inmunoadsorción Enzimática/métodos , Femenino , Humanos , Neoplasias Laríngeas/microbiología , Masculino , Persona de Mediana EdadRESUMEN
Helicobacter pylori (HP) is an accepted cause of chronic active gastritis and has a major causative role in peptic ulcers. It is a gastric carcinogen. Its role in nonulcer dyspepsia (NUD) is less clear, yet 50% of patients with NUD are infected with HP, and some recent literature demonstrates long-term improvement of symptoms following eradication. HP has been investigated in several other organ systems, but has not been investigated to any major degree in laryngeal disorders, a region that could be directly exposed to the bacterium from pharyngolaryngeal reflux. This study represents one arm of a larger study designed to investigate such a relationship. Of 101 patients with nonmalignant voice disorders presenting to our voice clinics, 54.5% tested positive for the H. pylori organism. Of the controls, 47.1% tested positive. When striated into age groups of < 45 years, 46-61 years, and > 62 years, and then age-matched with the controls, the likelihood of infection with the H. pylori organism was greater in both the experimental middle group, and in the middle group when combined with the elder group, than in the matched controls, and this difference demonstrated a trend approaching statistical significance. This finding is discussed in the light of other studies on HP and on gastroesophageal reflex (GER).
Asunto(s)
Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/microbiología , Helicobacter pylori , Enfermedades de la Laringe/epidemiología , Enfermedades de la Laringe/microbiología , Adulto , Femenino , Reflujo Gastroesofágico/diagnóstico , Reflujo Gastroesofágico/epidemiología , Reflujo Gastroesofágico/etiología , Humanos , Enfermedades de la Laringe/complicaciones , Masculino , Persona de Mediana Edad , Prevalencia , Índice de Severidad de la Enfermedad , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/epidemiología , Trastornos de la Voz/etiologíaRESUMEN
Canalplasty is the surgical procedure whereby the external auditory meatus is widened. The indications include exostoses, stenosing external otitis and widening for surgical access. One hundred consecutive ears operated on by one surgeon are reported. The surgical technique is described in detail, paying particular attention to bone removal from the anterior canal wall. In this paper the majority of cases were occasioned by soft tissue rather than bony stenosis. The re-stenosis rate was four per cent and in each case this was associated with the use of a middle temporal artery flap. Partial, transient, delayed facial palsy occurred in two per cent, probably relating to thermal injury transmitted from the burr. A full, spontaneous recovery of facial function occurred in each case. This is a safe and effective technique for canal widening.
Asunto(s)
Conducto Auditivo Externo/cirugía , Parálisis Facial/etiología , Femenino , Humanos , Masculino , Dolor Postoperatorio/etiología , Complicaciones Posoperatorias/etiología , Recurrencia , Remisión Espontánea , Estudios Retrospectivos , Cicatrización de HeridasRESUMEN
The use of inhaled steroids in the treatment of asthma is not without its complications. In some studies up to 50% of such patients complain of oropharyngeal and voice problems. We present the findings in 22 patients complaining of dysphonia who underwent videostrobolaryngoscopy (VSL) and computerized speech analysis. A number of abnormalities were identified. On VSL, these included mucosal changes (noted in 58%), apposition abnormalities (noted in 43%), and supraglottic hyperfunction (noted in 40%). On speech analysis, cycle-to-cycle irregularity was frequently noted (mean of 39%). Maximum phonation time was reduced in 73%. Our findings did not confirm the widely held views that steroid dysphonia is due primarily to a fungal infection or a steroid-induced adductor myasthenia of the larynx. A larger-scale prospective study is indicated.
Asunto(s)
Esteroides/administración & dosificación , Esteroides/efectos adversos , Trastornos de la Voz/inducido químicamente , Administración por Inhalación , Adolescente , Adulto , Anciano , Asma/tratamiento farmacológico , Diagnóstico por Computador , Femenino , Glotis/fisiopatología , Humanos , Laringoscopía , Laringe/patología , Masculino , Microscopía por Video , Persona de Mediana Edad , Fonación , Proyectos Piloto , Esteroides/uso terapéutico , Pliegues Vocales/patología , Trastornos de la Voz/diagnóstico , Trastornos de la Voz/fisiopatología , Calidad de la VozAsunto(s)
Oído Externo/patología , Otitis Externa/diagnóstico , Enfermedad Crónica , Constricción Patológica/complicaciones , Constricción Patológica/diagnóstico , Constricción Patológica/cirugía , Oído Externo/cirugía , Nervio Facial/patología , Fibrosis/patología , Fibrosis/cirugía , Humanos , Otitis Externa/complicaciones , Otitis Externa/cirugía , Procedimientos Quirúrgicos Otológicos , Membrana Timpánica/patología , Membrana Timpánica/cirugíaRESUMEN
Sudden onset sensorineural deafness is an otological emergency; subsequent recovery of hearing has been shown to correlate with early treatment. There have been few documented reports of this occurring in pregnancy, although the increased thrombogenic risk of the pregnant state is a proposed aetiological factor. The wide variation in outcome is demonstrated by these two cases, which are presented to raise awareness of this condition.
Asunto(s)
Pérdida Auditiva Súbita/etiología , Complicaciones del Embarazo , Adulto , Audiometría de Tonos Puros , Femenino , Humanos , EmbarazoRESUMEN
As the prevalence of tuberculosis in the U.K. increases, uncommon clinical presentations of the disease may be encountered by the otolaryngologist. We describe just such a case, where a caucasian patient presented with laryngeal lesion, considered to be highly suspicious of a neoplastic process rather than an infective one. We discuss the pathogenesis of tuberculous laryngitis, and review the differential diagnosis and management of the condition.
Asunto(s)
Neoplasias Laríngeas/diagnóstico , Mycobacterium tuberculosis , Tuberculosis Laríngea/diagnóstico , Anciano , Anciano de 80 o más Años , Antibacterianos , Diagnóstico Diferencial , Quimioterapia Combinada/uso terapéutico , Resultado Fatal , Femenino , Humanos , Laringe/patología , Tuberculosis Laríngea/tratamiento farmacológicoRESUMEN
In a prospective study of 50 patients undergoing tonsillectomy the pain scores over the first 14 days were recorded. The scores for those patients 10 years or younger were compared with those older than 10. The results showed a significant difference between the distribution of pain over the course of time between the two groups. The mean pain scores on day 1 were similar in the two groups but in the older group the level of pain recorded daily remained fairly constant until day 9 when it fell to around half the initial score. In the younger children the pain scores peaked at day 2 but thereafter fell to approximately half the peak score by day 6. The analgesic intake in each group mirrored these findings.
Asunto(s)
Dolor Postoperatorio/etiología , Tonsilectomía/efectos adversos , Acetaminofén/administración & dosificación , Acetaminofén/uso terapéutico , Adolescente , Adulto , Factores de Edad , Analgésicos/administración & dosificación , Analgésicos/uso terapéutico , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/uso terapéutico , Analgésicos Opioides/administración & dosificación , Analgésicos Opioides/uso terapéutico , Niño , Dextropropoxifeno/administración & dosificación , Dextropropoxifeno/uso terapéutico , Dieta , Disección , Combinación de Medicamentos , Electrocoagulación , Estudios de Seguimiento , Hemostasis Quirúrgica , Humanos , Dimensión del Dolor , Dolor Postoperatorio/tratamiento farmacológico , Hemorragia Posoperatoria/etiología , Estudios Prospectivos , Tonsilectomía/métodosRESUMEN
Packing of the nasal cavity following intranasal surgery is still widely practised. The removal of this packing is invariably associated with a significant amount of pain. We designed a prospective randomised case-controlled study to look at the efficacy of 4% lignocaine solution as a potential analgesic in the removal of Merocel nasal packs. Each patient had bilateral packs and acted as his or her own control with one pack being rehydrated with lignocaine and the other with saline. We found that there was a reduction in the level of discomfort experienced on the side rehydrated with lignocaine, although this reduction did not reach significance. We emphasize the importance of rehydration of these packs prior to removal.
Asunto(s)
Anestésicos Locales/administración & dosificación , Formaldehído , Hemostáticos , Lidocaína/administración & dosificación , Nariz/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Alcohol Polivinílico , Complicaciones Posoperatorias/prevención & control , Anestésicos Locales/uso terapéutico , Estudios de Casos y Controles , Femenino , Humanos , Lidocaína/uso terapéutico , Masculino , Dimensión del Dolor , Hemorragia Posoperatoria/prevención & control , Estudios Prospectivos , Tampones QuirúrgicosRESUMEN
Epistaxis is a common problem amongst anti-coagulated patients. Application of first-aid principles can control the majority of bleeds. In our sample of 60 patients attending the anticoagulant clinic, 40% were unable to think of a single measure that would be helpful in controlling a nose bleed. 6 weeks after being given first-aid advice the proportion of patients able to recall at least three first-aid principles had improved from 8% to 50%. First-aid education in this respect was well received and there was a good recall rate. Provision of advice verbally backed up by a printed sheet gave best rates of recall.
Asunto(s)
Anticoagulantes/efectos adversos , Epistaxis/prevención & control , Educación del Paciente como Asunto , Epistaxis/etiología , Primeros Auxilios , Humanos , Factores de RiesgoRESUMEN
OBJECTIVE: To investigate the level of lay knowledge of first aid measures for epistaxis, and to determine the effectiveness of an ENT department policy of providing an advice sheet of first aid measures. METHODS: 50 patients presenting with epistaxis were questioned on the accuracy and level of their knowledge of the four basic procedures used to combat a nose-bleed. The results were correlated with the source of referral, previous treatment, and advice. RESULTS: A large proportion of patients who had previously been treated for epistaxis by their general practitioners and other non-ENT trained medical or nursing staff were unable to recall being given any first aid advice. For those who remembered being given advice, very few described all the steps correctly. In contrast, patients who had previously been seen by the ENT staff scored full points in every aspect. CONCLUSIONS: The results are a reflection of the departmental policy of supplying information sheets outlining the first aid measures to all patients presenting with epistaxis.
Asunto(s)
Epistaxis/terapia , Primeros Auxilios/métodos , Educación del Paciente como Asunto , Humanos , OtolaringologíaRESUMEN
After arterial reconstruction, patients have traditionally been followed up in clinic in the long term. We have pursued a policy of limited clinic follow-up, with an 'open access' service for suspected graft failure (and latterly duplex scanning surveillance for vein grafts). This policy was assessed by measurement of the success of self-referral, graft patency and patient satisfaction after operation for lower limb ischaemia in 173 patients. At median follow-up of 50 months, 61 (35%) patients had died and 45 (25%) had required amputation. Of those with salvaged limbs and available for follow-up, 55 (86%) patients reported continuing symptomatic improvement with a graft patency rate of 80%. During the review period, 27 (42%) patients had presented themselves on suspicion of graft occlusion and 14 (52%) of these had required surgical intervention. Of the patients, 45 (70%) found a single postoperative clinic visit helpful, and the majority thought that further visits would not have been helpful to them. Limited clinic appointments seem especially desirable for elderly patients for whom journeys are an imposition, as well as reducing travel costs, and giving surgeons more time to deal with new referrals. These results suggest that properly educated patients present themselves when signs of graft occlusion occur, and there is little to be gained by regular long-term clinic follow-up in vascular surgical practice.