ENT Patients Research Articles

New oral anticoagulants - a guide for ENT surgeons.

New oral anticoagulants have been developed to overcome the perceived disadvantages of more traditional anticoagulants such as heparin and warfarin, and their use amongst ENT patients have been increasing. This review article aims to discuss the mechanism of action of new oral anticoagulants, when they should be used and a protocol for their use, in both the bleeding patient and in the peri-operative setting. It is important that ENT surgeons are aware of the use of new oral anticoagulants, and have a departmental- and trust-based policy on their use and reversal in bleeding and surgical patients.

Pattern of Ear Diseases among Pediatric ENT Patients: An Experience from a Tertiary Care Hospital, Hapur, India

Pattern of Ear Diseases among Pediatric ENT Patients: An Experience from a Tertiary Care Hospital, Hapur, India

Measures aimed at optimization of medical assistance to patients with respiratory chlamydiosis

The research was aimed at formulation of scientific groundings for activities on improvement of organization of medical assistance for patients with respiratory chlamydiosis of upper respiratory tract based upon intra­family infection. The laboratory research methods included identification of two types of Chlamydia: Chlamydia Pneumoniaе and Chlamydophila Trachomatis. To identify Chlamydia infection in organized population we used such method as direct immunofluorescent analysis. To verify Chlamydia infection in ENT­patients and their family members we used two direct tests simultaneously (direct immunofluorescent analysis and polymerase chain reaction) and one indirect test of immune enzyme analysis. The article presents the data on the prevalence of Chlamydia infection of nasal and pharynx mucosa in different populations: in organized children and adults, and in patients who underwent in-patient treatment of the diseases of nose, paranasal sinuses and nasopharynx resulted from insufficiency of out-patient medical care. We revealed the association of Chlamydia infection with the possibility of occurrence of acute and chronic pathology in children as well as chronic pathology in adults with breakdown by separate nosological forms. We found out that the presence of Chlamydia-infected ENT patient in a family provokes intra-family distribution of the infection. We present the structure of infection contamination of family members and the specific features of manifestation of family respiratory Chlamydiosis. We have substantiated the necessity of the measures, aimed at improvement of medical assistance for patients with respiratory Chlamydiosis from scientific viewpoint and worked out a program, determining the prioritized directions of the disease morbidity decrease. Therefore, implementation of the program aimed at optimization of providing medical care to patients with Chlamydia infection of upper respiratory tract will enable preventing the prevalence of respiratory Chlamydiosis, including the elimination of intra family centers of infection and reducing of social and economic consequences of Chlamydiosis.

Introducing a realistic and reusable quinsy simulator.

An increasing number of inexperienced doctors are rotating through otolaryngology departments and providing care to ENT patients. Numerous acute ENT conditions require basic surgical or technical intervention; hence, effective and efficient simulation induction training has become paramount in providing a safe yet valuable educational environment for the junior clinician. Whilst simulation has developed over the years for numerous ENT skills, to date there has not been a realistic and easily reproducible model for teaching the skills to manage one of the most common ENT emergencies, a peritonsillar abscess or 'quinsy'. We have adapted the Laryngotech trainer, a well-established ENT simulation tool, to present a readily accessible, reusable and realistic simulation model. The model provides safe training for the drainage of quinsy.

An audit assessing the accuracy of discharge documentation for ENT patients and the financial implications of errors and omissions

An audit assessing the accuracy of discharge documentation for ENT patients and the financial implications of errors and omissions

Implementing the WHO surgical checklist: Audit of ENT patients

Implementing the WHO surgical checklist: Audit of ENT patients

Peripheral Facial Palsy: Does Patients' Religiousness Matter for the Otorhinolaryngologist?

In order to deal with the suffering, a frequent strategy employed by patients is the use of religious beliefs and behaviors. Nevertheless, few studies in otorhinolaryngology have investigated this dimension. Therefore, the present study aims to investigate the role of religiousness on quality of life, mental health, self-esteem and appearance in 116 patients with peripheral facial palsy (PFP). A cross-sectional, single-center study was carried out between 2010 and 2012 in PFP outpatients. We assessed socio-demographic data, PFP characteristics, depression, anxiety, quality of life, self-esteem, appearance and religiosity. A linear regression (adjusted for confounders) was performed to investigate whether religiosity was associated with any outcomes. The present study found that religious attendance, but not other types of religiousness, was related to quality of life and mental health on PFP patients. In addition, ENT patients would like their doctors to ask them about their faith and religion as part of their medical care. These findings give further support to the importance of religious and spiritual beliefs on ENT patients. Otorhinolaryngologists should be aware of the positive and negative aspects of religion and be prepared to address these issues in clinical practice.

PSS53 - The Impact of the German Drg-System on Policy Decision Making in Ent

The German diagnosis-related groups (G-DRG) have been introduced as a reimbursement system for in-patient care. The aim of this study was to report on clinic-based data available from the G-DRG browser regarding the impact of middle ear implantation as a basis for future health care decision making in ear, nose and throat medicine (ENT). Using a clinical algorithm, the unevaluated D23Z database from 2012 was analyzed to determine epidemiological characteristics of patients with different types of hearing losses and receiving middle ear implants (MEI). All ICD-10 Codes used for the diagnosis of conductive (CHL), mixed (MHL) or sensorineural hearing loss (SNHL) were extracted. The number of MEI cases reported in the D23Z was analyzed regarding Patient Clinical Complexity Level (PCCL), age, sex and duration of stay. The incidence of MEI candidates to the total number of ICD-10 codes and per indication were calculated. According to the D23Z, approximately 30`000 individuals admitted to ENT clinics were diagnosed with a hearing loss. About 38% suffered from CHL, 8% suffered from MHL and 48% suffered from SNHL. The proportion of patients who received a MEI per indication were respectively 0.8% for SNHL, 8% for MHL and 1% for CHL. Overall, about 466 (1%) patients received a MEI. 49.8% of them were men and 50.2% were women. Children aged as young as 1-2 years could also receive treatment. All patients had normal-term stay in hospitals with no comorbidities or complications (PCCL <4 in 99.2% of cases) The incidence of MEI to the ENT patient base and the German population were respectively 15.5/1,000 and 0.6/100,000. The overall number of middle ear implantations compared to standard treatments is quite low. Analyzing data on MEI available from highly-developed DRG systems can be used by other countries for policy decision making in ENT.

Gastroesophageal and extraesophageal reflux symptoms: similarities and differences.

The association between extraesophageal reflux (EER) and symptoms of gastroesophageal reflux disease (GERD) is inadequately understood. We used the Comprehensive Reflux Symptom Scale (CReSS) to evaluate EER and reflux-symptom prevalence in gastroenterology and otolaryngology outpatients and symptom awareness among UK gastroenterologists. Cross-sectional cohort survey. Six hundred thirty-nine participants were surveyed: 103 controls, 359 patients undergoing esophagogastroduodenoscopy (EGD), and 177 otolaryngology clinic patients with throat symptoms. Participants completed the CReSS questionnaire. The study was undertaken in the Endoscopy Unit and the Department of Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne Hospitals, Newcastle-upon-Tyne, United Kingdom. Registered members of the British Gastroenterology Society were asked to rate how frequently reflux patients might complain of each CReSS item. The median CReSS total in volunteers (4) was significantly lower (P < .002) than in ear, nose, and throat (ENT) patients (26) or EGD patients with (42) or without (32) esophageal inflammation. All items were scored as ≥1 by >15% of ENT patients and 28% of EGD patients. Three major, robust CReSS factors: esophageal, pharyngeal, and upper airway emerged. Of 259 gastroenterologists, >20% scored 8 of the 34 symptoms as never being reported by reflux patients. Endorsement of each EER CReSS item by 28% to 58% of patients with endoscopic evidence of GERD supports the Montreal consensus on an EER-GERD continuum. Gastroenterologists vary considerably in their appreciation of EER symptom relevance. The advantages of CReSS include standardized, comprehensive capture of patient experience; discriminant validity of ENT and GERD patients from volunteers; and discrete esophageal, pharyngeal, and upper airway subscales. 4.

The intranasal Schirmer test: a preliminary study to quantify nasal secretion

Adequate secretion of the nasal mucosa is essential for normal nasal physiology. A "dry" nose is a frequent complaint of ENT patients. Measurement of secretion is currently impossible because of the absence of a recognized test. The aim of the present study was to investigate the feasibility of an intranasal Schirmer test in a large number of patients and to define standard values for nasal secretion. The test population comprised 159 healthy, non-smoking volunteers and 30 healthy smoking volunteers. All subjects were examined by nasal endoscopy for anatomic or mucosal disease. A Schirmer test strip was placed on both sides of the mucosa of the anterior nasal septum by anterior rhinoscopy. After 10 min in standardized conditions, the strip was removed and the wetted distance was measured. Active anterior rhinomanometry (ARR) and acoustic rhinometry (AR) were later performed. In the non-smoking group (n = 159), the median wetting distance of the test strip was 10.3 mm (range 3.6-35.0 mm). Age, gender, nasal geometry, and flow (according to ARR and AR) had no significant influence on nasal secretion. The test for normal distribution was negative. In the smoking group (n = 30), the median wetting distance was 8.4 mm (range 2.5-28.0 mm), significantly shorter than the wetting distance in the non-smoking group (p < 0.05). The Schirmer test offers a practical method to quantify mucosal humidification. The test is inexpensive and well tolerated by patients. In healthy people, wetting distances from 6 to 18 mm are considered normal.

Diagnostic Significance of Combined Detection of Epstein-Barr Virus Antibodies, VCA/IgA, EA/IgA, Rta/IgG and EBNA1/IgA for Nasopharyngeal Carcinoma

The objective of this study was to investigate the diagnostic significance of EBV antibody combined detection for nasopharyngeal carcinoma (NPC) in a high incidence region of southern China. Two hundred and eleven untreated NPC patients, 203 non-NPC ENT patients, and 210 healthy controls were recruited for the study. The titers of VCA/IgA and EA/IgA were assessed by immunoenzyme assay, and the levels of Rta/IgG and EBNA1/IgA were determined by enzyme-linked immunosorbent assay. The levels of VCA/IgA, EA/IgA, Rta/IgG and EBNA1/ IgA demonstrated no association with gender or age (p>0.05). The receiver operating characteristic curve and the area under the curve were used to evaluate the diagnostic value. The sensitivity of VCA/IgA (98.1%) and the specificity of EA/IgA (98.5%) were the highest. When a logistic regression model was used to combine the results from multiple antibodies to increase the accuracy, the combination of VCA/IgA+Rta/IgG, whose area under the curve was 0.99, had the highest diagnostic efficiency, and its sensitivity, specificity and Youden index were 94.8%, 98.0% and 0.93 respectively. The data suggest that the combination of VCA/IgA+Rta/IgG may be most suitable for NPC serodiagnosis.

The importance of side marking in preventing surgical site errors.

Wrong site confusions are among the most common mistakes in operations of twosome organs. To examine the frequency of wrong sided confusions that could theoretically occur in various surgeries in the absence of preoperative verification. Ten cataract surgeons, twelve orthopedic surgeons and 6 ENT surgeons participated in the study. The surgeons were asked to fill a questionnaire that included their demographic data, occupational habits and their approach to and handling of patients preoperatively. On the day of operation the surgeons were asked to recognize the side of the operation from the patient's name only. At the second stage of the study, surgeons were asked to recognize the side of the operation while standing a two meter distance from the patient's face. Surgeons' answers were compared to the actual operation side. Patients then underwent a full "time out" procedure, which included side marking before the operation. Of a total of 67 ophthalmic patients, 52 orthopedic patients and 26 ENT patients the surgeons correctly identified the operated side in 111 (76.5%) by name and in 126 (87%) by looking at patients' faces. Wrong side identification correlated with the time lapsed from the last preoperative examination (p = 0.034). The number of cataract surgeries performed by the same surgeon (on the same day) also correlated to the number of wrong identifications (p = 0.001) in ophthalmology. Orthopedic surgeons were more accurate in identifying the operated site Surgeon seniority or age did not correlate to the number of wrong identifications. This study illustrates the high error that can result in the absence of side marking prior to cataract surgery, as well as in operations on other twosome organs.

Blood otorrhea: Blood stained sweaty ear discharges: Hematohidrosis; four case series (2001–2013)

IntroductionHematohidrosis/hematidrosis/hemidrosis is a rare clinical condition in which human being sweats blood under condition of extreme physical or emotional stress [1. Jerajai HR, Bhagyashri Jaju, Phiske MM, and Nitin Lade. Hematohidrosis-a rare clinical phenomenon. Indian J Dermatol. 2009 Jul-Sep; 54(3): 290–292; 2. Martinez NL, Mas IB, Paz AFM, Boronat JL. Recurrent bleeding in an 18-year old girl. Arch Dermatol.2012; 148(8):960–961.] The capillary blood vessels that feed the sweat glands rupture, causing them to exude blood as sweat, under stressful conditions, occurring in religious (Jesus Christ prayer experience in Gethsemane) and non-religious (soldier sweat blood before battle) [2. Martinez NL, Mas IB, Paz AFM, Boronat JL. Recurrent bleeding in an 18-year old girl. Arch Dermatol.2012; 148(8):960–961.]. It is a condition where there is a spontaneous painless bleeding through unbroken skin in any part of the body. It is self-limiting in nature with a good prognosis [3. Patel RM, Mahajan S. Hematohidrosis: A rare clinical entity. Indian Dermatol Online J.2010 Jul; 1(1):30–2.]. The diagnosis of hematohidrosis is made on the presence of bloody discharge without any obvious cause through intact skin, witnessed and confirmed by health professional/doctor/nurse and the presence of blood components on biochemistry studies of the discharge. Hematohidrosis is a well-recognised diagnosis according to International Classification of Diseases (ICD-9-CM: 705–89) (ICD9 Data.com; 2013). Case reportThis study reports the clinical finding, radiology, audiology and histology of four cases of a rare isolated otological hematohidrosis. Our cases are of particular interest because to our knowledge these are the first documented cases of psychogenic hematohidrosis isolated otological (ear) presentation. DiscussionA comprehensive literature review was performed on reports documenting hematohidrosis/hematidrosis cases. The clinical presentation, diagnosis, treatment, pathophysiology and epidemiology of hematohidrosis. The purpose is to report and raise awareness of hematohidrosis among ENT patients.

Epidemiologic variation in pediatric ear, nose, and throat diseases: pediatric emergency admissions in two different regions of Turkey

Introduction: Acute pediatric ear, nose, and throat (ENT) diseases are common, but the causes may vary in different regions. Early diagnosis and suitable management modalities can decrease morbidity and/or mortality rates. Method: In two different university hospitals in Turkey, pediatric ENT diseases were evaluated retrospectively and recorded. We evaluated 5473 patients at Eskisehir Osmangazi University, and 1954 patients at Malatya Inonu University, during the 3- year study period. Results: The study population included 3013 males (56.5%) and 2460 females (43.5%) from Eskisehir Osmangazi University and 852 males (43.6%) and 1102 females (56.4%) from Inonu University. The age range of all patients was from 1 month to 17 years; mean age was 6.3 years for patients from Eskisehir Osmangazi and 9.6 years for patients from Inonu. At Eskisehir Osmangazi, the most common causes of admittance were acute tonsillitis (2314 cases, 42.3%), upper respiratory tract infections (1763, 32.22%), acute otitis media (453, (8.28%), foreign bodies (106,1.94%), and epistaxis (141, 2.58%). Other less common causes included maxillofacial traumas (2.74%), croup (2.76%), epiglottitis (0.09%), retropharyngeal abscess (0.03%), otitis externa (2.16%) and acute sinusitis (4.9%). At Inonu, 930 (47.6%) patients had acute otitis media, 272 (13.9%) patients had epistaxis, 265 (13.6%) patients had acute tonsillitis, and 233 (11.9%) patients had upper respiratory tract infection. Other causes included foreign bodies (10.6%), dysphagia (0.8%), and otitis externa (1.6%). Infectious diseases were more common in patients aged 1-6 months at Eskisehir and in patients aged 1 month to2 years at Inonu. Conclusion: Pediatric emergency physicians successfully treated more than 90% of the ENT patients in our study population. Training for emergency room management of pediatric ENT diseases is important to prevent unnecessary hospitalizations. The etiology of pediatric emergency cases differs greatly between regions, even in the same country.

Success and failure factors for hearing-aid prescription: Results of a French national survey

To identify epidemiological, socioeconomic, audiometric and environmental factors of success and failure of hearing-aid prescription, and to assess hearing-aid efficacy at 6-9 months after prescription. A prospective nationwide survey was conducted in France on 184 patients with age-related hearing loss. Inclusion data were collected by a questionnaire filled out by the ENT specialist and patient, and with a second questionnaire filled out by telephone contact with the patient 6-9 months later. One-third of patients failed to fulfill the prescription, either for financial reasons or for lack of interest in correcting their disability. For the other two-thirds, the factors favoring consultation with a hearing-aid fitting specialist seemed to be: leisure activity requiring good hearing, living in a couple or family, spontaneous initial ENT consultation, strong motivation, monthly income greater than €1200, longstanding hearing impairment, and difficulty in listening to television and following a conversation in noise. Eighty percent of hearing-aid trials were successful; 60% of prescriptions were thus followed by hearing-aid purchase. The main three criteria determining purchase were the advice of the hearing-aid fitting specialist, and the price and the effectiveness of the apparatus on trial. In the four daily life situations presented in the questionnaire, the hearing-aid was worn for 8 hours or more in 90% of cases, found useful in 70% and proved satisfactory in 70%. Age-related hearing loss, whether metabolic or sensorineural, benefited from hearing-aid correction in 86% of cases. Indications for hearing-aid prescription should take account of the patient's degree of motivation, awareness of disability, and income. The advice of the ENT and hearing-aid fitting specialists plays a key role in the patient's acceptance of the hearing-aid. Hearing-aids seem to enhance quality of life significantly in age-related hearing loss subjects.

Venous thromboembolism in ENT surgery: a review of the literature and completed audit cycle of adherence to national guidance

Venous thromboembolism (VTE) risk assessment of elective ENT patients is essential to minimize the risk of mortality and morbidity. The study is standard-based audit of VTE risk assessment against the ENT UK guidelines and intervention includes instructional poster and departmental presentation. 23 patients on eight operating lists were audited in the first cycle (C1). A total of 27 patients on ten operating lists were re-audited in the second cycle (C2). There were marked improvements in the number of VTE risk assessments completed (C1 = 3/23; C2 = 26/27; p < 0.0001), the number of patients encouraged to mobilize (C1 = 0/23; C2 = 26/27; p < 0.0001), and the number of VTE leaflets provided upon discharge (C1 = 1/23; C2 = 27/27; p < 0.0001) following the intervention. The introduction of a poster and a departmental presentation proved to be simple, cheap, and effective measures to improve adherence of national VTE guidelines.

Epstein-Barr Virus DNA Load in Nasopharyngeal Brushings and Whole Blood in Nasopharyngeal Carcinoma Patients before and after Treatment

Nasopharyngeal carcinoma (NPC) is consistently associated with Epstein-Barr virus (EBV) and highly prevalent in Indonesia. EBV-DNA load can be used for early diagnosis and may have prognostic value. In this study, EBV-DNA load was evaluated in minimal invasive nasopharyngeal (NP) brushings and whole blood for initial diagnosis and therapy assessment against the standard-of-care diagnosis by biopsy with EBV-RISH and standard EBV-IgA serology. NP brushings and blood samples were collected from 289 consecutive ENT patients suspected of NPCs and 53 local healthy controls. EBV-DNA load was quantified by real-time PCR and serology by peptide-based EBV-IgA ELISA. Tissue biopsies were examined by routine histochemistry and by EBER RNA in situ hybridization. Repeated NP brushing was well tolerated by patients and revealed high viral load in the 228 NPC cases at diagnosis than 61 non-NPC cancer cases and healthy controls (P < 0.001). The diagnostic value of EBV-DNA load in blood and EBV-IgA serology was inferior to the NP brush results. The level of EBV-DNA load in brushes of patients with NPC was not related to T, N, or M stage, whereas elevated EBV-DNA load in blood correlated with N and M stage. EBV-DNA levels in brushings and whole blood showed a significant reduction at 2 months after treatment (P = 0.001 and P = 0.005, respectively), which was not reflected in EBV-IgA serology. NP brush sampling combined with EBV-DNA load analysis is a minimal invasive and well-tolerated diagnostic procedure, suited for initial diagnosis and follow-up monitoring of NPCs.

Perceptions of doctors' dress code: ENT patients' perspective

Perceptions of doctors' dress code: <scp>ENT</scp> patients' perspective

Asthma diagnosis and treatment – 1026. Long term twice weekly dose of methotrextate in steroid dependent chronic allergic diseases

Methods Evaluated the use of oral or IM low-dose methotrexate vs placebo in steroid-dependent asthma patients using either parallel or crossover design. 100 patients enrolled in study attending the ent and allergy centre (India)panchkula patients were on long term steroid therapy for more than 1 years. Age of patients between 30 to 50 years. Study comparing methotrexate, 10 mg weekly orally, or placebo.

Ophthalmic Manifestations in ENT Diseases & Surgical Procedures

Objective: A prospective study was conducted in the department of ENT to see the incidence, Prevalence, Symptoms, signs and etiopathogenesis in relation to ophthalmic manifestations in ENT diseases and various ENT surgical procedures (iatrogenic). Material and methods: 35 cases were selected from IN and OUT patients of the department between July 1st 2008 to June 30th of 2009. 26 cases of orbital complications were due to various ENT diseases and 9 cases were of ENT surgical procedures with orbital complications. The standard otolaryngological and ophthalmological examination was carried out and thereafter proper hematological, radiological and histopathological examinations were done. After reaching the diagnosis, proper management was carried out. Result :35 cases of orbital complications were reported in ENT Department. Out of which, 29 cases were due to various ENT diseases and 6 cases were iatrogenic, caused by various ENT surgical procedures. Commonest ENT disease responsible for orbital complication is sinonasal tumours. Carcinoma maxilla was the most common tumour responsible for the orbital complications. Sinonasal tumours involving eye were found in wide age group range of 11 to 75 years, with higher incidence in males. Incidence of sinusitis complicating orbit is decreasing. Variety of ENT surgical procedures can involve orbital . Total maxillectomy has higher incidence of orbital complications. Conclusion: A variety of ENT diseases & surgical procedures can present with orbital complications due to anatomical association of orbit with the surrounding head and neck structures. Orbital involvement must be ruled out whenever an ENT patient presents with orbital complaints .Rapid diagnosis and treatment is necessary for preserving vision and life in these patients. Teamwork between ophthalmologist and the otolaryngologist is required for the appropriate management of such lesions.