Department Of ENT Surgery Research Articles

Unlocking safety: Ultrasound's role in tracheostomy

Ultrasound imaging has become a valuable tool in Percutaneous Dilatational Tracheostomy (PDT), aiding in airway assessment and management. However, the risk of complications, including bleeding, highlights the importance of careful pre-procedural evaluation and management to ensure patient safety. A 75-year-old female with hypoxic encephalopathy required prolonged mechanical ventilation and was scheduled for PDT. Prior to the procedure, ultrasound identified two vascular structures anterior to the laryngotracheal region, prompting consultation with the ENT surgery department and cancellation of the procedure at the bedside. Subsequent tracheostomy in the operating room proceeded without incident.

Post-intubation laryngotracheal stenosis: clinical presentation and management approaches

IntroductionAddressing acquired laryngotracheal stenosis presents a complex healthcare dilemma.ResultsWe present a case series of 48 acquired post-intubation laryngotracheal stenosis cases managed within our Department of ENT Surgery at Farhat Hached Tunisia. Diagnosis relied on imaging and endoscopic findings. Among these cases, 28 exhibited tracheal stenosis, with 60% falling into grade 2–3 severity. Management approaches included sole endoscopic dilation for 17 patients, surgical intervention for 19 patients, and T-tube placement for 10 patients.ConclusionsThe management of laryngotracheal stenosis poses a challenge for ENT surgeons. Prevention is paramount, encompassing various measures such as employing high-volume, high tracheostomy, and extended intubation practices.

Multimodal strategies to improve surgical outcome: Our protocol management in the ENT Surgery department

Multimodal rehabilitation brings together the experience from health professionals from de fields of surgery, anesthesia, nursery and nutrition with the main objective of becoming the standard management necessary to improve the healthcare quality of surgical patients. According to statistics from our country, in the last 5 years the 70% of the surgery of the head and neck were performed by ENT specialists. Because of this, our special interest in the perioperative management of the nutritional state, pain, stress, immune modulation. We present the protocol of our Unit of Head and Neck Surgery in pharyngolaryngeal surgery.

Hemodynamic complications during microlaryngeal surgery

Introduction: Successful anesthetic management of microlaryngeal cases requires a high degree of cooperation with the surgeon, a reciprocal understanding of the potential problems, and adequate preparation on both sides to meet the anticipated challenges that may arise. The Aim of the study is to determine the hemodynamic complications during microlaryngeal surgery. Materials and Methods: A 5-year prospective cohort study of 200 patients who underwent microlaryngeal surgery in the Department of ENT Surgery; University Hospital “Queen Giovanna”- ISUL; Medical University-Sofia. All patients were monitored and recorded for: Systolic blood pressure (SBP), Diastolic blood pressure (DBP); heart rate (HR); continuous electrocardiography (ECG). The above parameters were recorded and analyzed at predetermined time intervals: 5-th minute before intubation, every 5 minutes after intubation and 5-th minute after extubation. Results and discussion: Mean systolic blood pressure of the patients during the operation is 147.33 mmHg, mean diastolic blood pressure is 93.5 mmHg and mean pulse rate is 57.64 beats per minute. 49% of the patients have arterial hypertension I grade during the operation, 28% of them are with isolated arterial hypertension and 23% are with normal blood pressure. 40% of the patients had pulse rate between 45-60 beats per minute during putting on the tube of Kleinsasser, 29% of them had pulse rate>60 beats per minute during putting on the tube of Kleinsasser and 31% had pulse rate<45 beats per minute during putting on the tube of Kleinsasser. Conclusion: Microlaryngeal surgery is specific kind of surgery which is characterized by hypertensive hemodynamic. There is a risk of severe bradycardia after putting on the tube of Kleinsasser which can cause hemodynamic instability and even cardiac arrest if not corrected immediately.

Hearing loss in the pediatric age group

Background: Hearing loss is one of the preventable diseases listed by the WHO, even though the prevalence is decreasing in the developed countries. The pediatric age is very important in terms of hearing and therefore speech development. The prevalence and pattern of hearing loss in this age group in this environment is not known. Objective: The aim of the study was to determine the etiology and pattern of hearing loss in the pediatric age group in Port Harcourt. Materials and Methods: The study involved the pediatric age group (0-18 years) presenting with hearing loss, seen in the ENT Surgery Department of UPTH from January 2010 to December 2016. The clinic registers and patients' folders were the sources from which the biodata, clinical presentations, audiological assessments, possible etiologies, and treatment were extracted. These were analyzed using IBM SPSS Statistics, version 20.0. Results: A total of 752 patients with hearing impairment were seen: males – 502 and females – 250 with a ratio of 2.01:1. Patients with the age group of 0–3 years (28.6%) were more affected, whereas 16–18 years (11.2%) were the least affected. Sensorineural hearing loss (SNHL) was 37.6%; among this, birth asphyxia made up 38.5%, syndromic 6.0%, postmeningitis (2.7%, and neonatal jaundice 21.9%. However, conductive hearing loss (62.4%); was made up of cerumen auris (31.8%), otomycosis (19.4%), chronic suppurative otitis media (13.6%), Otitis media with effusion (11.7%). Most children with SNHL had severe-to-profound degree. The most common clinical presentation was hearing impairment and speech impairment followed by discharging ears. Conclusion: Hearing loss secondary to preventable causes such as birth asphyxia and neonatal infections still ranks high among the pediatric age group in this environment.

Hemodynamic Complications During Laser Surgery of the Larynx

Introduction: Laser surgery of the larynx offers several advantages over conventional surgical methods, including a bloodless operative field and microscopic precision. However, the anesthetist faces special issues in the management of these patients. The Aim of the study is to determine the hemodynamic complications during laser surgery of the larynx. Materials and Methods: A 2-year prospective cohort study of 50 patients who underwent laser microsurgery of the larynx in the Department of ENT Surgery; University Hospital „Queen Giovanna”- ISUL; Medical University-Sofia. We used total IV anesthesia. All patients were monitored and recorded for: Peripheral Capillary Oxygen Saturation (SpO2); Systolic blood pressure (SBP), Diastolic blood pressure (DBP); heart rate (HR); continuous electrocardiography (ECG). Results and discussion: The mean age of the patients is 61.04 years. 8% of them are females and 92% are males. According to anesthesia risk assessment 4% of the patients are with ASA 1 class, 30% of them are with ASA 2 class, 64% are with ASA 3 class and 2% are with ASA 4 class. The mean duration of operation is 57.06 minutes. Mean systolic blood pressure of the patients is 141.22 mmHg, mean diastolic blood pressure is 86.2 mmHg and mean pulse rate is 60.94 beats per minute. 44% of the patients have arterial hypertension I grade, 24% of them are with isolated arterial hypertension and 32% are with normal blood pressure. 44% of the patients had pulse rate between 45-60 beats per minute during putting on the tube of Kleinsasser, 32% of them had pulse rate&gt;60 beats per minute during putting on the tube of Kleinsasser and 28% had pulse rate&lt;45 beats per minute during putting on the tube of Kleinsasser. Conclusion: Laser surgery of the larynx is specific kind of surgery which is characterized by hypertensive hemodynamic. There is a risk of severe bradycardia after putting on the tube of Kleinsasser which can cause hemodynamic instability and even cardiac arrest if not corrected immediately.

Upper Airway Instrumentation in Patients with Laryngeal Obstruction

Introduction: Ontogenetically the larynx is subdivided into supraglottis, glottis and subglottis. Difficult intubation requires the preparation of a preliminary plan for establishing ventilation of the patient if the intubation proves impossible. Aim: The aim of the study is to characterize the proposed various techniques for upper airway instrumentation in patients with laryngeal obstruction. Materials and methods: Clinical prospective cohort study including 120 patients undergoing laryngectomy in the Department of ENT Surgery; University Hospital „Queen Giovanna“ – ISUL, Sofia, in the period 2012-2015, for determining the degree of laryngeal obstruction and depending on it, application of different techniques for upper airway instrumentation during the tracheostomy. The patients were subdivided into the following groups: Group 1 (n = 40): tracheostomy under local anesthesia with preservation of spontaneous breathing and oxygen administration through face mask; Group 2 (n = 40): tracheostomy under general anesthesia and ventilation through endotracheal tube; Group 3 (n = 40): tracheostomy under general anesthesia and ventilation through laryngeal mask. Results and discussion: Characterization of the anesthetic techniques during the tracheostomy: under local anesthesia with preservation of spontaneous breathing and oxygen administration through face mask, under general anesthesia and ventilation through endotracheal tube or ventilation through laryngeal mask and the anesthesia after intubation through the tracheostomy. Conclusion: Depending on the degree of laryngeal obstruction, different methods for upper airway instrumentation can be successfully used for upper airway instrumentation.

P31. Urgent suspected Head and Neck Cancer Audit – A retrospective study of ENT suspected cancer referrals in the department of ENT surgery at Ysbyty Gwynedd, Bangor

Background: Head and Neck USC referrals are expedited within a targeted time limit of less than 2 weeks, since they are associated with significant mortality and morbidity. This study evaluated the time course taken for these referrals to be seen and subsequent management of these patients.

Skull base osteomyelitis: Incidence of resistance, morbidity, and treatment strategy

The pathogeny of osteomyelitis of the skull base has evolved over time with the emergence of ciprofloxacin-resistant Pseudomonas strains and significant fungal infections, both of which seem to bring a higher morbidity. The aims of this study were 1) to document the incidence of ciprofloxacin-resistant Pseudomonas aeruginosa over the past 7 years; 2) to assess morbidity by a radiologic score, the occurrence of cranial nerve palsies, and the duration of the hospital stay, according to the pathogenesis; and 3) to propose a treatment strategy. Retrospective chart review of necrotizing external otitis cases from 2004 to 2011. The setting was the Department of ENT Surgery, Lariboisière Hospital, Paris. Thirty-one patients were included. Radiological scores were assessed based on the initial computed tomography scans or magnetic resonance imaging, which specified the anatomical territory involved. Nerve palsies, the duration of hospitalization, and the radiological scores were analyzed with regard to the pathogen. Twenty-eight patients had a bacterial disease. Of the 20 strains of P. aeruginosa identified, five (25%) were ciprofloxacin-resistant P. aeruginosa. Three patients (10%) had a fungal infection due to Aspergillus flavus. Nerve palsies, radiological scores, and hospitalization durations were significantly higher for patients with resistant strains and A. flavus. In our series, the prevalence of ciprofloxacin-resistant Pseudomonas strains increased over time. Along with fungal infections, they formed a group with a higher morbidity than that of ciprofloxacin-sensitive Pseudomonas infections that furthermore did not respond to oral outpatient treatment. This is why pathogen identification using biopsies is sometimes required to start a prolonged treatment.

Management of parotid gland surgery in a university teaching hospital

The aim of our study was the evaluation of two controversial procedures used in surgical management of parotid tumours in a university teaching hospital: fine needle aspiration cytology (FNAC) and continuous operative facial monitoring with nerve integrity monitor (NIM). We present a retrospective study of 96 consecutive cases of parotid gland surgical procedures, performed in our department of ENT Surgery (Bichat University Hospital) during a 2-year period. After the exclusion of nine patients (4 recurrent tumours, 3 insufficient data and 2 obviously malignant tumours with preoperative facial paralysis and necessary peroperative facial nerve sacrifice), the final group included 40 men and 47 women (mean age 46 years). FNAC, final histological diagnosis, NIM use, postoperative facial disorders and operative time were analysed. Other variables included age, sex, type of surgery and other postoperative complications. FNAC: 78 patients underwent FNAC. Positive predictive value for malignancy was 100%; negative predictive value 94.4%; sensitivity 63.6%; specificity 100%. NIM: surgery was performed without NIM for 41 patients, with for 46 patients. There was no significant difference in occurrence of facial disorders between the two groups. Operative time was significantly lower in group operated with NIM for extracapsular dissection, superficial parotidectomy and total parotidectomy. Because continuous efforts of modern health systems to improve operating room schedules may threaten resident surgeons training, using NIM and performing preoperative FNAC may help operative planning and improve medical education in a teaching hospital.