Otorhinolaryngology Patients Research Articles

Deep neck space infections of odontogenic origin are costly and preventable.

Deep neck space infections (DNSI), caused by the spread of an odontogenic infection to the floor of the mouth and neck, are potentially life-threatening but preventable. We explored the total cost of illness (COI) for patients with DNSI of odontogenic origin. Cross-sectional, register-based, multi-centre study of the health economics of DNSI treatment. Included were patients aged > 18 years who were treated in hospital for DNSI of odontogenic origin. Subjects were identified from the regional healthcare database VEGA based on the International Classification of Diseases (ICD) codes and surgical procedure codes. The cost per patient (CPP) values for the hospital care, prescription medications and sick leave were extracted. In total, 148 patients were included. The average length of the hospital stay was 6 days. Total COI was estimated as 15,400 EUR per patient and 2,280,000 EUR in total. Direct costs accounted for 93% of the COI, and indirect costs were 7%. The total COI for patients with DNSI of odontogenic origin was six-fold higher than the average COI for patients in otorhinolaryngology (ORL) care. Preventing DNSI will entail substantial cost savings for the specialised healthcare units and will have a significant impact on the patients.

Perioperative Effect of Nursing Model Based on Nursing Quality Evaluation System in Otorhinolaryngology Patients

Background: To explore the perioperative effect of the evaluation system of nursing quality in otorhinolaryngology patients. Methods: A total of 100 patients hospitalized in the Department of Otorhinolaryngology of the Third Affiliated Hospital of Qiqihar Medical College, Qiqihar City, China in 2019 were selected as the control group, and routine nursing mode was adopted. The control group was data before the implementation of this study. A total of 100 patients (experimental group) hospitalized in the Department of Otolaryngology in 2020 were selected to adopt the nursing model constructed by nursing quality evaluation system. The adverse mood of patients in the two groups were evaluated at admission and discharge, and postoperative pain and satisfaction were compared between the two groups. Results: Anxiety, depression and quality of life scores were improved in both groups, but the degree of improvement in experimental group was significantly higher than that in control group (t=481.759, 353.502, P＜0.05）, and the postoperative pain score in experimental group was lower than that in control group (t=54.086, P＜0.05). The satisfaction of experimental group was better than that of control group (χ2=30.327, P＜0.05). Conclusion: The nursing model based on the evaluation system of the nursing quality of otorhinolaryngology can relieve patients' adverse emotions, relieve postoperative pain of otorhinolaryngology patients, and improve patient satisfaction. Therefore, it is worth popularizing and applying in the future.

Incidence of Post COVID-19 Rhinosinusitis Among Otorhinolaryngology Patients in New Damietta

Incidence of Post COVID-19 Rhinosinusitis Among Otorhinolaryngology Patients in New Damietta

Fresh Fractures: A New Indication for Use of Bone Allografts-A 10-Year Data Analysis.

Tissue banking includes the process starting from procurement to the distribution and usage of allograft tissues. The use of bone bank in orthopaedics is not widely seen. Our objective is to describe the 10-year allograft donor and recipient data from a fully functioning tissue bank in India, analyse the types of grafts used, indications and demand for various grafts. This will show the need for a tissue bank in a tertiary care orthopaedic setup. Analysis of donor and recipient data for allografts of a tissue bank in an Indian tertiary care setup was done from 2012 to 2022. The number of grafts procured and used were analysed. The recipient and donor sites were also analysed. In 10years, the tissue bank provided 2776 grafts and received 1962 donations. Slices procured after total knee replacements were the most commonly used allografts (28.03%). Acute fracture with bone loss or severe comminution (23.11%) being the most common indication of bone grafting was a major result of our study. Among these, proximal tibia (27.79%) was the most frequent recipient site. Tissue bank has also served patients in neurosurgery, ophthalmology, oromaxillofacial surgery, otorhinolaryngology, urology and wound care. A tissue bank is a useful setup in tertiary care orthopaedic hospitals. Allografts were most widely used for acute trauma management. Allografts provide large graft quantity and reduce surgical time. Hence a tissue bank is not only an asset to the establishment but also to the surrounding hospitals, to which the grafts can be supplied.

Anwendung der Kontrastmittelsonografie im Kopf-Hals-Bereich: Update

With the help of contrast enhanced ultrasound, the diagnostic accuracy of conventional sonography can be increased in many areas of otorhinolaryngology. Vascularisation and tissue perfusion can be objectified through the examination. This offers promising approaches for example to monitor the therapy of metastatic cervical lymph nodes or in the treatment of vascular malformations. Contrast Enhanced Ultrasound (CEUS) also offers great potential for differential diagnosis, for example of thyroid nodules. Valid threshold values for the quantitative time intensity curve (TIC) analysis of cervical pathologies are currently still not available. Further studies are necessary. As there is currently no license for the use of contrast enhanced ultrasound in otorhinolaryngology patients must be informed about its off-label use before the examination. This article is intended to provide an overview of the current possibilities and to serve as an introduction to the topic.

Virtual visits at the Helsinki Head and Neck Center during the COVID-19 pandemic: patient safety incidents and the experiences of patients and staff

BackgroundDuring the COVID-19 pandemic, health care had to find new ways to care for patients while reducing infection transmission. The role of telemedicine role has grown exponentially.MethodsA questionnaire on experiences and satisfaction was sent to the staff of the Head and Neck Center of Helsinki University Hospital and to otorhinolaryngology patients treated remotely between March and June 2020. Additionally, patient safety incident reports were examined for incidents involving virtual visits.ResultsStaff (response rate 30.6%, (n = 116)) opinions seemed to be quite polarized. In general, staff felt virtual visits were useful for select groups of patients and certain situations, and beneficial in addition to face-to-face visits, not instead of them. Patients (response rate 11.7%, (n = 77)) gave positive feedback on virtual visits, with savings in time (average 89 min), distance travelled (average 31.4 km) and travel expenses (average 13.84€).ConclusionsWhile telemedicine was implemented during the COVID-19 pandemic to ensure patient treatment, its usefulness after the pandemic must be examined. Evaluation of treatment pathways is critical to ensure that quality of care is upheld while new treatment protocols are introduced. Telemedicine offers the opportunity to save environmental, temporal, and monetary resources. Nonetheless, the appropriate use of telemedicine is essential, and clinicians must be offered the option to examine and treat patients face-to-face.

The design of a user-centred m-health application for caregivers of children undergoing ORL surgery

Abstract Background In the context of common surgical procedures in pediatric otorhinolaryngology (ORL) patients, providing for education to families for hospitalization, surgery, and postoperative home management has been shown to improve peri-operative outcomes. In this regard, the use of Mobile Health Applications (MHA) is increasing. However, for these tools to be needs-appropriate and effective, their development requires a user-centred approach. Methods Our study aimed to explore the informational needs and preferences - in terms of features and functionalities - of health care providers and ORL patients’ caregivers (end-users) to inform the development of an MHA supporting ORL peri-operative process effectively. The study was conducted at a 136-bed maternal and child health hospital in Trieste. A user-centred participatory study design was employed, and the methodology steps were informed by the 3 cycles of the Information System Research Framework (Schnall et al., 2016). Results The Relevance cycle was performed to better understand the environment as well as end users’ (64 participants) informational needs and desired features for the MHA. Five critical information/education moments of the ORL perioperative period were identified. In the Rigour cycle a literature review was performed to identify further key topics relevant to understanding ORL end-users’ needs and relevant features for the MHA. In the Design cycle the final contents were defined to be displayed on the MHA spread across the 5 identified moments. A randomized controlled trial will then be conducted to evaluate the effectiveness of the MHA compared to standard care. Conclusions Triangulation of data sources collected by experts, ORL patients’ caregivers, and healthcare professionals ensured the rigour of the methodology adopted in the study. Moreover, such a MHA user-centred developed MHA favours end-users positive health outcomes and organizational benefits of health services. Key messages

Impact of the COVID-19 and Socioeconomic Status on Access to Care for Otorhinolaryngology Patients.

Since December 2019, COVID-19 has greatly influenced public healthcare systems around the globe in various aspects, including limitation of healthcare accessibility due to lack of both human and financial resources, suspension of clinics, and fear of infection causing healthcare avoidance. The aim of this study was to investigate the impact of COVID-19 on access to healthcare for otorhinolaryngology patients from different socioeconomic status (SES) groups. Otorhinolaryngology patients’ disease severity status, diagnosed at the first hospital visit, was investigated during the pre -and post-COVID-19 pandemic era in a single medical center located in Seoul, Korea. An ordinal regression model was used to assess the impact of both SES and the COVID-19 pandemic on otorhinolaryngology diseases. Within the chronic rhinosinusitis group, lower SES was associated with a higher disease severity at the first visit compared to higher SES (OR = 3.25). During the COVID-19 pandemic, while the total number of outpatients was reduced, the severity of these ENT diseases seemed to increase compared to the pre-pandemic severity in every SES group. Our study demonstrates the negative impact a worldwide pandemic can have on healthcare inequity and disease severity, and highlights the importance of re-allocating fundamental resources for those in need during periods of public health crisis.

Otorhinolaryngology Virtual Visits During the COVID-19 Pandemic: A 2-Year Follow-Up Study.

Objective: To clarify how successful virtual visits were in different age groups and subspecialties of otorhinolaryngology during the COVID-19 pandemic, with a 2-year follow-up. Methods: We examined the progress of treatment and need for face-to-face follow-ups in a retrospective setting. Case records of all the visits marked as virtual between March and June 2020 in Helsinki University Hospital Department of Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) were reviewed. Results: Among 865 virtual visits, 71.2% (n = 616) clearly advanced treatment, 53.8% (n = 465) needed no face-to-face follow-up, and only 9.0% (n = 78) were followed by an unplanned visit within 6 months. Statistically significant differences were detected among different subspecialties and age groups. Virtual visits achieved clear progress of treatment most frequently in laryngology (119/149 visits, 79.9%) and in head and neck surgery (69/83 visits, 83.1%). Laryngology patients required the least face-to-face follow-ups (n = 38 scheduled, 25.5% of laryngology visits). Most visits with clear progress involved 18-29-year-olds (n = 100, 80.0%) and they also required least face-to-face follow-ups (n = 39, 31.2%). During the 6-month to 2-year follow-up, 82 patients (9.6%) contacted our clinic directly for outpatient treatment, 28 patients (3.3%) called or visited the emergency department, and 37 patients (4.3%) were referred to the ORL-HNS clinic again for the same issue. Conclusion: Virtual visits were beneficial for treatment of otorhinolaryngology patients, and unplanned visits afterward were rare. Differences in effectiveness among subspecialties suggest that the utility of telemedicine applications can be enhanced by examining more closely which patient and ailment characteristics favor virtual visits.

Information and communication technologies in the justification of X-ray examination of otorhinolaryngology patients

Objective . To propose a methodology for using the possibility of wider inclusion of study groups in solving the problem of information transfer in the diagnosis of ENT diseases based on the results of X-ray imaging. Materials and methods . Examination of ENT patients, information on the results of X-ray imaging, analysis of information technologies for the exchange of medical information and software used to study DICOM files, anonymization of computer diagnostic images. Results . The problem of ENT disease diagnosis has been studied. We have proposed an information and communication structure for the exchange of medical images and a methodology for generating a data set for use in ENT disease studies and for consultations. Conclusion . The availability of publicly available medical databases undoubtedly contributes to the development, early understanding of the diagnosis, teaching of anatomy, pathological anatomy to representatives of medical specialties and researchers.

Telemedicine in Thai-otorhinolaryngology patients in COVID-19 situation; primary surveys.

COVID-19 pandemic has put a strain on various aspects of hospital management due to high rates of infection and increased preventive measures around the world. Physicians and patients alike are susceptible to the ongoing virus causing concern leading to loss or postpone of follow up. Thailand has just start integration of digital solutions such as telemedicine which expected similar level of medical care and efficiency while reducing risk of exposure during the COVID-19 pandemic. Evaluation the willingness to accept telemedicine in otorhinolaryngology patients during the peak COVID-19 outbreaks in our institution. Collected data from all patients who had a schedule follow up for otorhinolaryngology department between the months of June to August, 2021 at out-patient Center. Total of 299 otorhinolaryngology patients included, 213 patients (71.2%) denied a virtual medical visit whereas 86 patients (28.8%) accepted. The obstructive sleep apnea (OSA) was the only group to have more acceptance of telemedicine, 79.5% than denying 20.5% with statistical significance (p < 0.01). Age difference between the accepting and declining group also showed statistical significance, 48.5 years and 56 years respectively (p < 0.01). Main Reasons for their decision, 48% of patients accepted due to experiencing clinical improvement and stability. The main reason for not accepting telemedicine was 80% of patients preferred a special otorhinolaryngologic examination on follow up. This primary surveys among Thai otorhinolaryngology patients about telemedicine. The greater number of patients not interested in telemedicine due to requirement of otorhinolaryngologic examination. Which OSA follow-up patients have more attention in telemedicine.

THE IMPACT OF COVID-19 PANDEMIC ON DIAGNOSIS AND TREATMENT IN OTORHINOLARYNGOLOGY PATIENTS IN CROATIA.

COVID-19 pandemic resulted in a decrease in the number of diagnostic and therapeutic procedures in most ENT departments. We performed a survey among ENT specialists in Croatia aiming to assess how the pandemic influenced their practice, and consequently the patient diagnosis and treatment. The majority of the 123 participants who completed the survey stated that there was a delay in diagnosis and treatment of ENT diseases, which they expected to have negative effects on patient outcomes. Since the pandemic is still ongoing, there is the need for improvement at different levels of the healthcare system to minimize the consequences of the pandemic in non-COVID patients.

О РАЗВИТИИ АНТИБИОТИКОРЕЗИСТЕНТНОСТИ В АСПЕКТЕ ПОЛИКЛИНИЧЕСКОЙ СЛУЖБЫ

Background. Antibiotic resistance is a worldwide problem that is the main cause of the increase in the number of purulent-inflammatory diseases and postsurgical complications. Aim. The aim of the present study was to monitor antibiotic resistance of microorganisms isolated in the course of microbiological study in otorhinolaryngological and surgical patients of the outpatient department of a single preventive health institution. Material and methods. A statistical analysis of the results of microbiological studies, excretions of patients undergoing outpatient treatment in surgical and otorhinolaryngological departments of outpatient clinic No1 of the state budget institution «City Clinical Hospital No 7» of Tver is presented. We processed 280 findings of microbiological studies of ear, nose, pharynx and wound surface cultures for 2019. Results and discussion. It was found that the spectrum of dominant microorganism species in 2019 detected during swabbing of surgical and otorhinolaryngological patients treated in the outpatient clinic included gram-negative Escherichia coli and Klebsiella pneumonia and gram-positive Staphylococcus aureus and Streptococcus pyogenes microorganisms. Among the microorganisms presented, strains with multiple resistance to the action of antimicrobial drugs were identified. According to the total number of resistant microorganisms it was found that among antibacterial drugs, antibiotics of Aminopenicillin class, including those protected by protease inhibitors, as well as fluoroquinolones of the 2nd generation have the lowest clinical efficacy in the given medical institution. Conclusion. The findings of the present study indicate a rapid rate of spread of resistance genes among nosocomial strains of microorganisms, which necessitates continuous monitoring of antibiotic sensitivity by various specific laboratory methods. The results of laboratory studies should be used when prescribing antibiotic therapy for a particular patient, and the results of this study should be considered when selecting an empirical antibiotic, since they reflect the resistance of the most common pathogens. Key words: antibiotic resistance, antibiotics, cephalosporins, fluoroquinolones.

Otorhinolaryngological contusions in mine-explosive injury

Modern trends in the conduct of military conflicts dictate their own characteristics of the formation of the size and structure of sanitary losses of the otorhinolaryngological profile. Combat trauma to the organ of hearing is characterized not only by an increase in the total number of sanitary losses, but also by various features of the course of the wound process. The organ of hearing, with the development of weapons, becomes an increasingly unprotected and vulnerable area of impact of mine explosive weapons. However, such important characteristics as treatment, duration, and outcomes of ear, throat, and nose contusions are not sufficiently presented for adequate organization of medical support. Otorhinolaryngological contusions were considered in the total mass of contusion sanitary losses with a predominance of closed brain injury and often without taking into account otorhinolaryngological contusions. Victims completed treatment in separate medical battalions, hospitals and wards for the lightly wounded. The number of injured by shrapnel and concussion increases with the use of explosive weapons, due to an increase in associated wounds. The experience of the Great Patriotic War showed that otorhinolaryngological shell-shocked patients in frequency account for about 32.5% of all shell-shocked, therefore, in 67.5% of the remaining shell-shocked otorhinolaryngological contusions were concomitant, the main manifestation of the trauma was a closed brain injury. Otorhinolaryngological shell-shocked patients are a special case of general contusion or concussion-contusion syndrome from the direct impact of a sharp drop in air pressure during explosions. The leading manifestation of otorhinolaryngological contusion syndrome is vestibular and auditory disorders, decreased hearing acuity with a whole eardrum, which occurred in all victims. There were also neurological abnormalities such as short-term loss of consciousness, dizziness, fading nystagmus, stuttering, etc., which subsided a few days after the start of conservative therapy.

The Effectiveness of the Malaysian Guidelines for Pre-operative COVID-19 Screening in ORL Patients Undergoing Elective Surgery

The Coronavirus disease 2019 (COVID-19) pandemic is a devastating global pandemic affecting many countries worldwide. It has a huge impact on the country’s healthcare system as well as its socio-economic wellbeing. Majority of elective surgery was deferred in order to provide beds, resources and treat COVID-19 cases. Resumption of elective surgery requires a well-planned process and adherence to standard guidelines to protect both the healthcare providers and patients. Pre-operative COVID-19 screening will be one of the new norms for patients undergoing surgery. This study was aimed to evaluate the pre-operative COVID-19 screening for elective surgery among Otorhinolaryngology (ORL) patients in Hospital Ampang based on the current Malaysian guidelines for undertaking surgery during COVID-19 pandemic and highlight the screening protocols implemented by the Ministry of Health. This retrospective review was conducted in ORL Department, Hospital Ampang. We reviewed the surgical registry of 117 patients who underwent elective surgeries under general anaesthesia from June till September 2020. There were 62 patients (53%) below 18 years old and 55 patients (47%) above 18 years old. There were 76 cases (65%) involving aerosol-generating procedures. A total of 23 patients (19.7%) had COVID-19 screening done pre-operatively based on the Malaysian guidelines patient selection and all results were negative. None of the patients experienced any symptoms, complications or morbidities related to SARS-CoV-2 infection post-operatively. The Malaysian guideline on pre-operative screening for COVID-19 is applicable for institutions with low to moderate local transmission of SARS-CoV-2. Targeted group or risk-based protocols are beneficial for improving cost-effectiveness and reducing workload burden during the critical period. As the pandemic evolved, the guidelines have to be revised based on the prevailing situation to suit the best clinical practice for the benefit of patients and healthcare personnel without disrupting the surgical services.

Patient in the otolaryngology office in the time of the COVID-19 pandemic in the light of current recommendations, legal regulations and authors' own experience

Generally, COVID-19 is an acute contagious disease caused by the SARS‑CoV-2 virus. The main route of human-to-human transmission is through contact with infectious secretions from the respiratory tract. Clinical manifestations vary from mild non-specific symptoms to life-threatening conditions. Since WHO declared COVID-19 a pandemic in March 2020, it has affected many medical, legal, social and economic aspects of everyday life in countries around the world. In this article, the authors present a summary of recommendations for taking care of otorhinolaryngology patients in outpatient settings and the legal basis referring to a risk of infection in doctor's office. In the selection of articles, the authors used English- and Polish-language online medical databases, typing the following keywords: SARS‑CoV-2, COVID-19, otolaryngology, endoscopy, personal protective equipment, and legal responsibility of the physician. The mucosa of the upper respiratory tract is a potential site of virus replication. The specificity of an ear, nose and throat (ENT) examination and a direct patient-doctor contact favor the transmission of the infection. The authors discussed the elements of self-protection of medical personnel and the legal aspects a risk of the patient contracting the infection in the otolaryngology office. In the case of a direct contact with the patient, the following medical personal protective equipment is required: a cap, a mask with an FFP-2 filter, goggles, an apron and gloves. If, during the visit, exposure to secretions or aerosol from the respiratory tract is expected, the personnel should additionally wear a visor and a waterproof apron. The patient's visit in the clinic should be preceded by telemedicine consultation. Patients should be screened prior to having a direct contact with a physician, using a short patient questionnaire. The questionnaire may consist of simple questions about the characteristic symptoms of the SARS‑CoV-2 infection and exposure to a sick person in the past 14 days. The question of staying in the areas of a high infection risk appears of little importance in view of the whole of Poland being perceived as constituting such an area. Due to the spread of the SARS‑CoV-2 virus, new procedures for providing medical services have been introduced. In the case of claims on the part of the patient, the only protection the medical personnel or facility can provide is confirmation of scrupulous compliance with medical procedures . Med Pr. 2021;72(3):327-34.

Infection control measures during COVID-19 pandemic – An otorhinolaryngological and head-and-neck perspective

Otorhinolaryngologists and head-and-neck surgeons are considered as high-risk group of health-care workers due to their nature of work for exposure to the respiratory tract. During routine assessment and treatment of patients, otorhinolaryngologists and head-and-neck surgeons with their assisting staffs inevitably come in contact with secretions of the respiratory tract which may become aerosolized at time of the sneeze or cough. All otorhinolaryngology patients must be considered as potential carriers of COVID-19. A great emphasis must be given on the history such as flu-like symptoms, travel history, and contact history with potential carriers which will help triage patients into high risk. This review article discusses the infection control measures by otolaryngological and head-and-neck perspective during COVID-19 pandemic so will serve as template for otolaryngologists and head-and-neck specialist at the time of this outbreak.

30-day readmission rate in pediatric otorhinolaryngology inpatients: a retrospective population-based cohort study

ObjectivesAnalysis of frequency and reasons for planned and unplanned 30-day readmission in hospitalized pediatric otorhinolaryngology patients using German Diagnosis Related Group (G-DRG) system data.MethodsA retrospective population-based cohort study in Thuringia, Germany, was performed for the year 2015 with 2440 cases under 18 years (55.6% male) out of a total number of 15.271 inpatient cases. The majority of pediatric patients were from 2 to 5 years old (54.5%). The most frequent diagnoses were hyperplasia of adenoids or/and tonsils (26.6%). 36 cases (1.5%) experienced readmission within 30-days.Results30-day readmission was planned in 9 cases (25% of all readmission) and was unplanned in 27 cases (75%). The median interval between index and readmission treatment was 8 days. Postoperative bleeding after adenoidectomy, tonsillotomy/tonsillectomy or tracheostomy (33.4%) and infectious complications after surgery like acute otitis media, abscess formation or fever (36.2%) were the most frequent reasons for 30-day readmission. Compared to adults treated in 2015 in Thuringia, the readmission rate was higher in adult patients (8.9%) than in this pediatric cohort. In contrast to children, readmissions in adults were mainly planned (65.1%) with a different spectrum of underlying diseases and reasons for readmission.ConclusionThe 30-day readmission rate seemed to be lower for pediatric otolaryngology patients compared to adult patients. Unplanned readmissions dominated in pediatric patients, whereas planned readmissions dominated in adults.

The Impact of Socioeconomic Status on Hospital Accessibility in Otorhinolaryngological Disease in Korea.

This study aimed to investigate the impact of socioeconomic status (SES) on otorhinolaryngology disease severity status diagnosed at the first hospital visit. We conducted a retrospective study over 20 years (2000-2019). Otorhinolaryngological diseases included chronic rhinosinusitis (CRS), sensorineural hearing loss (SNHL), oral ulcer, and malignant neoplasms. A logistic regression model was employed to assess the effect of SES on the severity of each disease at the first hospital visit. The severity of CRS increased in patients with lower SES (P = .028). The severities of SNHL (P = .032) and oral ulcer (P < .001) also associated with SES. In contrast, between the low- and high-SES groups observed no differences in cancer stage (P = .845). Patients with SNHL, oral ulcer, and CRS had a more severe disease status in the low-SES group than in the high-SES group at the first hospital visit. Efforts to increase hospital accessibility for low-SES otorhinolaryngological patients should be made.

Mycobacterium leprae on Palatine Tonsils and Adenoids of Asymptomatic Patients, Brazil.

We investigated palatine tonsil and adenoid specimens excised from otorhinolaryngological patients in a leprosy-endemic region of Brazil. Fite-Faraco staining identified Mycobacterium spp. in 9 of 397 specimen blocks. Immunohistochemistry and molecular analysis confirmed the presence of Mycobacterium leprae, indicating that these organs can house M. leprae in persons inhabiting a leprosy-endemic region.