Nose Throat Research Articles

Investigating the nasal cycle using unilateral peak nasal inspiratory flow and acoustic rhinometry minimal cross-sectional area measurements.

To plot the nasal cycle using unilateral peak nasal inspiratory flow (UPNIF) and unilateral minimal cross-sectional area (UMCA) readings demonstrating a linear relationship in normal nasal function. Additionally, to determine how this changes in abnormal nasal function. A cross-sectional study measuring UPNIF and UMCA in controls demonstrating normal nasal function and in patients with nasal obstruction. Royal National Throat Nose and Ear Hospital, London. A total of 39 participants, 26 controls and 13 patients, were recruited. Controls exhibited normal nasal function with SNOT-22 <5. Patients nasal obstruction symptoms secondary to inflammation or structural abnormality with SNOT-22 >9. Airflow rates and resistance values were derived from UPNIF and UMCA measurements respectively based on Poiseuille's laws. Ratios between right and left UPNIF and UMCA values were taken to adjust for confounding factors. The relationship of 1/Resistance Ratio and Airflow Rate Ratio demonstrated a linear of direct proportionality of strong correlation and statistical significance (correlation coefficient=0.76, P«0.01). This suggests that data points from controls with a normal nasal cycle lie closely along the regressed line, whilst those lying significantly away were shown to belong to patients with nasal dysfunction. Olfactory dysfunction appears to be a sensitive discriminator in predicting this. This study demonstrates the directly proportional relationship of 1/Resistance Ratio and Airflow Rate Ratio in normal nasal function. Furthermore, nasal pathology can be predicted if data points lie significantly outside these normal limits. Further studies are needed to validate exact normal and abnormal thresholds.

Evaluation of balance function in patients with radiologically (CT scan) confirmed otosclerosis

Objective: To assess balance function in patients with radiologically confirmed otosclerosis. Methods: Sixteen patients (14 females and 2 males), who attended the Neuro-Otology clinic/ ENT clinics at the Royal National Throat Nose and Ear Hospital, participated in this study. After general medical, audiological and Neuro-Otological examination, patients underwent the caloric and rotational testing.&#x0D; Results: Thirteen of the 16 patients had radiologically confirmed otosclerosis (12 females and 1 male). A total of 3 patients (2 females and 1 male) did not have CT confirmation of otosclerosis, and therefore, were excluded from the study. The remaining 13 patients' data were analyzed. Nine patients had a mixed hearing impairment at least on one side, while eight patients had a bilateral mixed hearing loss and one patient had a sensorineural hearing loss on one side. Four patients had a bilateral sensorineural hearing loss. Only 1 patient had a canal paresis (CP) at 35 %. None of the patients had any significant directional preponderance (DP). The patient with significant CP (35%) did not show any rotational asymmetry on impulsive rotation. Eleven patients had a rotational chair test. Only one patient had a significant asymmetry to the right at 25.30% (normal range is &lt;20%). Overall, 18% (n = 2) of the radiologically confirmed otosclerosis patients showed an abnormal balance test, including both caloric and rotational tests. More than 80% (n = 9) of the patients with radiological otosclerosis showed balance symptoms.&#x0D; Conclusions: the current study indicates a high prevalence of balance symptoms (n = 9 or 82%) in patients with radiological otosclerosis, although only a small proportion (n = 2 or 18%) showed an abnormal vestibular function on caloric and impulse rotation testing. However, due to a small number of samples, further validation of this result is warranted.&#x0D;

MARKED FIRST-DEGREE ATRIOVENTRICULAR BLOCK ASSOCIATED WITH PSEUDO-PACEMAKER SYNDROME: A CASE REPORT

Distinctive atrioventricular type I heart block is diagnosed when the PQ interval is 0.30 s. or more. Prolongation of the PQ interval more than 0.50 s. is a very rare condition. Usually it is associated with a pseudo-pacemaker syndrome. The last one manifests itself with dizziness, syncope, general weakness, shortness of breath upon physical exertion, cough, seizures, cold sweat, a feeling of pulsation in the head, neck and abdomen, a headache, paroxysmal nocturnal dyspnea, swelling of the lower extremities, tachypnea and jugular venous pulsation. The P wave appears immediately after the previous QRS complex. Atrial contraction occurs at the moment when the ventricles don’t relax after the previous contraction; due to the fact that pressure in the ventricles at this moment is higher than in the atria, the tricuspid and mitral valves remains closed. During the atrial contraction, most of the blood is ejected not into the ventricles, but backward into the pulmonary veins from the left atrium and into the venae cavae from the right atrium. Also, an atrial kick is absent which results in a less ventricular filling. There is increased pressure in the atria leading to their distension and excessive secretion of the atrial natriuretic peptide.&#x0D; A case report of the distinctive atrioventricular type I heart block associated with the pseudo-pacemaker syndrome is described. The patient suffered from a pre-syncope, short-term dizziness during the previous two days, tinnitus, general weakness, feeling of pulsation in the abdomen, neck, head, which interfered with his sleep. He developed these complaints after an infectious disease, which manifested as a runny nose and sore throat. In this patient, an extremely prolonged PQ interval up to 0.70 s. was observed. Also, episodes of Mobitz I and Mobitz type II atrioventricular block were detected. During the monitoring of patient state, the interval PQ was gradually shortening, and in 1 month it reached the normаl duration.&#x0D; It can be assumed that in the case of distinctive atrioventricular type I heart block, a significant prolongation of the refractory period in the rapid pathways of the AV-node plays a key role in the pathogenesis of this condition.&#x0D; According to the recommendations of the ACC/AHA (1998), for patients with distinctive atrioventricular type I heart block accompanied by the pseudo-pacemaker syndrome and documented alleviation of symptoms with temporary AV pacing, the pacemaker implantation should be considered (IIaB). The implantation of dual chamber pacemaker may reduce symptoms and lead to an improvement in the functional state of patients, in whom shortening of the interval between atrial and ventricular contractions improves hemodynamics. For asymptomatic patients with the PQ interval of ≥ 0.30 s, pacemaker is not recommended. The distinctive atrioventricular type I heart block in patients with pseudo-pacemaker syndrome is a rare condition and often remains undiagnosed. But it may have a benign course with a gradual normalization of the PQ interval. Indications for permanent pacemaker implantation should be reviewed as this block may be completely reversible. A permanent pacemaker may be used in the case of absence of positive dynamics in a shortening of the PQ interval.&#x0D; &#x0D;

Hippocrates the otolaryngologist: an epidemiological analysis of ear–throat–nose diseases in the Corpus Hippocraticum

Introduction: Hippocrates, a Greek physician during the fifth century BC., is often considered the father of medicine. The Corpus Hippocraticum comprising of 58 volumes was attributed to him alone for a long time. Nowadays, it is considered that several authors contributed to its creation between 450 and 150 BC., so over a period of 300 years. The objective of our study was to develop a nosological classification of all passages treating head and neck diseases.Material and methods: We read and analyzed all volumes of the Corpus Hippocraticum in French translation and extracted all passages dealing with oto–rhino–laryngological and maxillo-facial conditions (n = 65). We classified all pathologies into five distinctive nosological groups: traumatic, infectious, malformation, cancerous and inflammatoryResults: Traumatic diseases represented 36.9% (n = 24), infectious 52.3% (n= 34), malformation 0% (n = 0), cancerous 11.5% (n = 1) and inflammatory 9.3% (n= 6). These results represent the living conditions of this era, during which diseases were mostly of infectious or traumatic nature (wars, physical labor and recreational sporting activity, living together on close quarters, etc.).Conclusion: The meticulously detailed observations of the corpus give us a precious insight into the early perception of diseases, their progression and early attempts of treatment.

Declining Maternally-Derived Measles Antibodies in Infants and Nursing Mothers in Nigeria: A Review

Measles, also reffered to as rubeolais an endemic respiratory disease caused by a virus. It is a highly contagious infection which typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, conjunctivitis and sore throat. Today, despite the availability of a safe, effective and relatively inexpensive vaccine for more than 40 years, measles still kills more than any other vaccines preventable disease among children. In Pregnant women, IgG immunoglobulin antibody is produced and crosses the placenta to developing fetus’ blood circulation; thereby conferring primary protection against infections in the early life of newborns. The presence or absence of Maternal Measles Antibody (MMA) in infants is therefore a factor to be considered in immunization of infants against measles. In Nigeria, the recommended age for routine measles vaccination for infants is at 9 month of age. However, it has been severely reported that the present-day civilized mothers are more measles vaccine-immuned contrary to been natural measles virus-immuned and as such, produce low titer anti-measles virus antibody which consequently decays or clears from their respective infants earlier than 9 months of age when measles vaccine is routinely administered. Early immunization against measles may potentially minimize the duration of the period between the loss of maternal antibodies transferred via the placenta and the administration of the recommended measles vaccination for infants, hence the need for the re-evaluation of the measles immunization schedule. Keywords: Vaccination; Maternal Measles Antibody; Infant, Virus;

Bleeding after tonsillectomy

Oropharyngeal hemorrhage after tonsillectomy is one of the most common postprocedural ENT emergencies that require immediate attention. Management choices depend on the severity of bleeding, underlying platelet or coagulation disorders, and the patient’s maturity and age. Treatment range from simple observation to an emergent need to both secure the airway and stop the hemorrhage. The workup of the hemorrhagic patient will be discussed from the preoperative to postoperative time period. Surgical techniques in response to various acuity will be discussed to fully elucidate options to control the hemorrhage.

Peak nasal inspiratory flow correlates with quality of life in functional endoscopic sinus surgery.

Whilst nasal function and airflow improve subjectively following functional endoscopic sinus surgery (FESS), a clinically useful and objective tool for quantifying such improvement is lacking. The peak nasal inspiratory flow (PNIF) metre offers convenient and objective measures of nasal patency. However, it has not yet been established whether changes in PNIF after surgery reflect changes in subjective disease burden. In this study we aimed to determine whether changes in PNIF correlate with commonly used subjective symptom and quality of life outcome measures following FESS for chronic rhinosinusitis (CRS). Prospective cohort. Royal National Throat Nose and Ear Hospital. Thirty-seven patients undergoing FESS for CRS, with or without polyps (21 male, mean age 48.8). PNIF, "SNOT-22", "NOSE" and "VAS" questionnaires were performed before and after surgery. In all patients, there was a strong negative correlation between change in PNIF and change in "SNOT-22" score following surgery (Pearson r=-.64, P<.0001). Strong negative correlations were also seen during subgroup analysis of patients with and without polyps (r=-.57, P=.006 and r=-.67, P=.005, respectively). Change in PNIF correlated significantly with change in "NOSE" score following surgery in all patients and those without polyps (r=-.54, P=.0005 and r=-.68, P=.003). There were no significant correlations between PNIF and VAS (nasal obstruction). Changes in PNIF after FESS appear to best reflect improvements in quality of life in CRS as measured using the "SNOT-22" questionnaire.

Unscheduled return visits to a pediatric emergency department

Background and objectiveReturn visits (RVs) to a pediatric emergency department (ED) within a short period after discharge have an influence on overcrowding of the ED and reveal some weaknesses of the health care system. The aim of this study was to determine the rate of RVs and factors related to RVs to the pediatric ED in Lithuania. Materials and methodsA retrospective study in an urban, tertiary-level teaching hospital was carried out. Electronic medical records of all patients (n=44097) visiting the ED of this hospital between 1 January and 31 December 2013 were analyzed. Demographic and clinical characteristics of patients who return to the ED within 72h and those who had not visited the ED were compared. Factors associated with RVs were determined by multivariable logistic regression. ResultsOf the overall ED population, 33889 patients were discharged home after the initial assessment. A total of 1015 patients returned to the ED within 72h, giving a RV rate of 3.0%. Being a 0–7-year old, visiting the ED during weekdays, having a GP referral, receiving of laboratory tests and ultrasound on the initial visit were associated with greater likelihoods of returning to the ED. Patients who arrived to the ED from 8:01a.m. to 4:00p.m. and underwent radiological test were less likely to return to the ED within 72h. Diseases such as gastrointestinal disorders or respiratory tract/earth–nose–throat (ENT) diseases and symptoms such as fever or pain were significantly associated with returning to the ED. The initial diagnosis corresponded to the diagnosis made on the second visit for only 44.1% of the patients, and the highest rate of the congruity in diagnosis was for injuries/poisoning, surgical pathologies (77.2%) and respiratory tract diseases (76.9%). ConclusionsRVs accounted for only a small proportion of visits to the ED. RVs were more prevalent among younger patients and patients with a GP referral as well as performed more often after discharging from the ED in the evening and at night.

The Prevelence of SBS and Absenteeism among Children in Urban Refurbished Private Preshools

The preschool education is compulsory to children in Malaysia. This regulation has encouraged more premises to be refurbished as a pre-school building. This paper examines the pupils’ absenteeism and the prevalence of Sick Building Symptoms (SBS) initiated in congested private preschool with different ventilation strategies. The study analysed data from the attendance record of 10 classrooms and the questionnaire surveys administered to 151 parents about their children health symptoms once they were leaving the schools building. Questions on SBS used 5-point likert scale with symptoms concern on nose, eye, head, throat, skin, breath and tiredness. The descriptive and chi-square test applied to obtain the association of SBS and ventilation strategies in the classrooms. With quantitative and qualitative explanation, the unhealthy environment in refurbished pre-schools explained. Running nose, coughing and sore throat frequently reported in air-conditioning (AC) classrooms. The higher absent rate found in AC classrooms. These symptoms show there were weaknesses in ventilation performance and environment in the selected preschools. Further analyses on objective measurements in future research are strongly recommended.

Transitional cell tumours of the lacrimal drainage apparatus

Background: Tumours of the lacrimal drainage apparatus (LDA) are very rare, but can be life-threatening. Seventy percent of lacrimal sac tumours are of epithelial origin, and transitional cell tumours represent an interesting sub-group of these epithelial tumours. Methods: A retrospective review of cases of LDA transitional cell tumours co-managed at the Royal National Throat Nose and Ear Hospital and Moorfields Eye Hospital, London. Results: Twenty cases of transitional cell tumours of the LDA were identified, comprising 10 transitional cell papillomas (TCPs) and 10 transitional cell carcinomas (TCCs). All cases were resected through a modified lateral rhinotomy approach. Limited resection of orbital fat with preservation of orbital functions was required for 2 cases of TCC. Fractionated external beam radiotherapy was administered in 7 cases of TCC. The mean follow up was 80 months (range 11 months-16 years). Recurrences were detected in 4 cases, which were managed by further surgery. Two cases have been lost to follow-up, but the 18 other patients are currently alive and disease free. Conclusion: A favourable outcome can be achieved with transitional cell tumours of the LDA when an optimum management plan is followed.

Transitional cell tumours of the lacrimal drainage apparatus

Tumours of the lacrimal drainage apparatus (LDA) are very rare, but can be life-threatening. Seventy percent of lacrimal sac tumours are of epithelial origin, and transitional cell tumours represent an interesting sub-group of these epithelial tumours. A retrospective review of cases of LDA transitional cell tumours co-managed at the Royal National Throat Nose and Ear Hospital and Moorfields Eye Hospital, London. Twenty cases of transitional cell tumours of the LDA were identified, comprising 10 transitional cell papillomas (TCPs) and 10 transitional cell carcinomas (TCCs). All cases were resected through a modified lateral rhinotomy approach. Limited resection of orbital fat with preservation of orbital functions was required for 2 cases of TCC. Fractionated external beam radiotherapy was administered in 7 cases of TCC. The mean follow up was 80 months (range 11 months-16 years). Recurrences were detected in 4 cases, which were managed by further surgery. Two cases have been lost to follow-up, but the 18 other patients are currently alive and disease free. A favourable outcome can be achieved with transitional cell tumours of the LDA when an optimum management plan is followed.

Spontaneous silent sinus syndrome (imploding antrum syndrome): case series of 16 patients

Silent sinus syndrome (SSS) is a rare idiopathic collapse of the maxillary sinus and orbital floor. We present the second largest series of sixteen patients with SSS and describe their management. A cohort of 16 patients with spontaneous SSS between 1999 and 2009 were reviewed at the Royal National Throat Nose and Ear Hospital. All patients were initially referred from a postgraduate ophthalmic hospital, Moorfields Hospital. Fourteen patients required endoscopic sinus surgery to re-establish maxillary sinus drainage and the remaining two settled with intranasal medical therapy consisting of steroids and decongestions. Follow- up ranged from 6 months to 4 years with a mean of 2.6 years. An improvement in enophthalmos and was seen in all surgically treated patients with a mean improvement of 2.2mm and range 0.5-4mm. SSS arises from congestion of the ostiomeatal complex resulting in negative pressure within the maxillary sinus and a gradual implosion of the antral cavity. Endoscopic sinus surgery successfully re-establishes maxillary aeration in our series and leads to clinical and aesthetic improvement in the degree of enophthalmos and has avoided the need for orbital floor repair in all but two cases.

Thomas James Wilmot

Thomas James Wilmot (“Tom”) was born in 1920, the third eldest in a family of two boys and two girls. He was born in England but his father was originally...

Seasonal allergic rhinitis: fluticasone propionate and fluticasone furoate therapy evaluated

Seasonal allergic rhinitis (SAR) is increasing in prevalence such that 1 in 4 persons is affected in the UK. It represents a considerable burden of disease since in a significant proportion of individuals the severity of nasal-ocular symptoms has an important effect on daily activity, performance and quality of life. Intranasal steroids (INS) form the mainstay of treatment, having been shown in meta-analyses to be superior to oral antihistamines, intranasal antihistamines and anti-leukotrienes. Fluticasone propionate is an established INS for the treatment of rhinitis, including SAR. Its favorable pharmacological profile combining high local efficacy with low systemic bioavailability has established fluticasone propionate as an effective intervention. The more recent introduction of structurally related fluticasone furoate with similar but enhanced pharmacological characteristics with a novel delivery device may confer further therapeutic advantages.

Mediastinal Castleman Disease: Embolization without Surgery

Mediastinal Castleman Disease: Embolization without Surgery

Joint Modeling of Time Series Measures and Recurrent Events and Analysis of the Effects of Air Quality on Respiratory Symptoms

Exposure to ambient pollutants at concentrations above defined standards is a risk factor for respiratory symptoms, especially in sensitive children. Many studies have been undertaken to monitor air quality and to assess its association with respiratory symptoms. We propose a joint mixed-effects regression model of time series measures and recurrent events to analyze the air quality and respiratory symptom data from the Yale Mothers and Infants Health Study. Three mothers' symptoms (runny nose, cough, and sore throat) and three infants' symptoms (runny nose, cough, and general sickness) were investigated. To alleviate the computational complexity, a two-stage maximum likelihood–based estimation procedure is introduced to estimate the parameters, and simulation studies are conducted to assess the validity of this estimation procedure. Our analysis reveals differences in the etiology of respiratory symptoms between mothers and infants. Most notably, coarse particles of mass between 2.5 and 10 μ in diameter increased the risks of mothers' runny nose and cough symptoms but had no significant effect on any of the three infants' symptoms. The sulfate level was negatively associated with the risk of infants' runny nose and cough symptoms but had no significant effect on any of the three mothers' symptoms. High level of humidity is negatively associated with the mothers' cough incidence but had no significant association with any of the three infants' symptoms. Such differences reveal not only the sensitivity of the mothers and infants to the air quality, but also call for further understanding of the differences. It is possible that actions taken to overcome humidity by mothers may inadvertently affect their infants.

Estimating the population incidence of adult post‐intubation laryngotracheal stenosis

Clinical OtolaryngologyVolume 32, Issue 5 p. 411-412 Estimating the population incidence of adult post-intubation laryngotracheal stenosis S.A.R. Nouraei, S.A.R. Nouraei Department of Otolaryngology, Charing Cross HospitalSearch for more papers by this authorE. Ma, E. Ma North West London Unit (Epidemiology), Health Protection AgencySearch for more papers by this authorA. Patel, A. Patel Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this authorD.J. Howard, D.J. Howard Department of Otolaryngology, Charing Cross Hospital Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this authorG.S. Sandhu, G.S. Sandhu Department of Otolaryngology, Charing Cross Hospital Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this author S.A.R. Nouraei, S.A.R. Nouraei Department of Otolaryngology, Charing Cross HospitalSearch for more papers by this authorE. Ma, E. Ma North West London Unit (Epidemiology), Health Protection AgencySearch for more papers by this authorA. Patel, A. Patel Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this authorD.J. Howard, D.J. Howard Department of Otolaryngology, Charing Cross Hospital Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this authorG.S. Sandhu, G.S. Sandhu Department of Otolaryngology, Charing Cross Hospital Royal National Throat Nose and Ear Hospital, London, UK E-mail: RN@cantab.netSearch for more papers by this author First published: 19 September 2007 https://doi.org/10.1111/j.1749-4486.2007.01484.xCitations: 77Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume32, Issue5October 2007Pages 411-412 RelatedInformation

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A Daily Nasal Spray with Saline Prevents Symptoms of Rhinitis

Objective—To ascertain whether a daily nasal spray with physiological saline could prevent symptoms of common cold in a population of otherwise healthy adults.Material and Methods—This was study involving 10 weeks of daily use of a nasal saline spray and 10 weeks of only recording symptoms. Young adults eligible for military service at an army barrack in Boden, Sweden were invited to participate in the study and 108 healthy conscripts aged ≈20 years agreed to do so. Data were recorded by the participants in a diary at home. In the diary the participants noted symptoms such as rhinitis, blocked nose, cough, fever and sore throat (pharyngeal pain). They also recorded inability to perform their duties due to the symptoms, and any medication or antibiotics necessitated by upper respiratory tract infection.Results—A total of 69 subjects completed the 20-week diary period. For 60 of them, compliance during the spray period exceeded 60% and their data were used in the statistical calculations. During the spray period the number of days with nasal secretion and/or blocked nose (mean 6.4 days) was significantly (p=0.027) lower than that during the observation period (mean 11 days). Furthermore, the participants had a mean of 0.7 episodes of upper respiratory tract infection during the spray period, compared with 1.0 episodes during the observation period (p=0.05).Conclusion—A daily nasal spray with saline can prevent nasal symptoms of common cold in a population of otherwise healthy adults.