Otorhinolaryngological Problems Research Articles

Otorhinolaryngological Problems in Mucopolysaccharidoses: A Review of Common Symptoms in a Rare Disease.

The mucopolysaccharidoses (MPSs) are very rare lysosomal diseases. MPSs belong to inherited diseases; however, newborns are usually asymptomatic. A deficiency of one of the enzymes, which is responsible for glycosaminoglycan (GAG) catabolism, results in the accumulation of this material. GAGs lead to progressive damage to tissues. More than 90% of patients with MPS suffer from otitis media with effusion or recurrent otitis media, craniofacial dysmorphia, obstructive sleep apnea, different types of hearing loss, and progressive upper and lower airway dysfunction. Patients visit otolaryngologists often before the diagnosis of MPS. Thus, the awareness of symptoms of MPS is crucial for otolaryngologists and pediatricians. The earlier the diagnosis is made, the more effective treatment is. Ineffective or delayed treatment leads to premature death. Two principal treatments for MPS are currently available: hematopoietic stem cell transplantation (HSCT) and enzyme replacement therapy (ERT). In recent years, there has been a growing interest in gene therapy as a potential treatment for patients with MPS. Mortality in patients with MPS typically occurs during childhood and early adolescence as a consequence of upper and lower respiratory diseases. This systematic review is based on papers available in the following scientific databases: MEDLINE (via PubMed), Web of Science, Scopus, and the Cochrane Library. After screening, 72 articles met our inclusion criteria. It is of paramount importance that otolaryngologists are involved in this field. This narrative review examines and synthesizes the otolaryngologic issues encountered in patients with MPS.

PARONASAL SINUS CYST (LITERATURE REVIEW)

A review of current problems in otorhinolaryngology is made, in particular cysts of the nasal adnexa, which develop among the most complex non-purulent processes. Cysts are mainly incidental abnormalities in the diagnosis of paranasal diseases. The work presents modern data on the etiology, pathogenesis, health characteristics, methods of diagnosis and treatment of cysts of paranasal diseases using the latest scientific achievements. The developed minimally invasive methods of surgical treatment, these principles, reduce the risk of developing postoperative complications and shorten the treatment time for patients. However, despite this, the question of the advantages and principles of various methods for removing cysts of accessory teeth, which have not yet been replaced by traditional solutions, remains controversial.

Комбинированный подход в лечении больных с хроническим полипозным риносинуситом

Targeted therapy has changed the approach to the management of patients with chronic rhinosinusitis with nasal polyps (CRwNP) type 2. However, the treatment of such patients remains one of the urgent problems in otorhinolaryngology, and the search for the optimal combination of treatment methods continues. Objective. To evaluate the effectiveness of combined treatment of patients with CRwNP. Material and methods. 50 patients with CRwNP were treated with dupilumab and mometasone furoate. Patients of the main group underwent endoscopic nasal polypectomy before using these drugs. The results of computed tomography of the paranasal sinuses (Lund-Mackay score and SNOT22 (Sino-Nasal Outcome Test)) were analyzed. Results. A significant decrease in the average SNOT-22 values was revealed in patients of the main group even before the start of dupilumab injections, in subjects from the comparison group, after 8 weeks. The average values on the Lund-Mackay score in patients of the main group were 21.3±2.5 and 7.0±1.1, in the comparison group, 20±2.2 and 7.5±1.3 before and after 6 months of treatment, respectively. Conclusions. Nasal polypectomy before the start of targeted therapy in patients with CRwNP type 2 and severe nasal obstruction helps improve the quality of life according to the SNOT-22 before starting treatment with dupilumab.

SPECTRUM OF OTORHINOLARYNGOLOGICAL PROBLEMS AMONG PAEDIATRIC AGE GROUP AT A TERTIARY HOSPITAL OF NEPAL

Background: Otorhinolaryngological problems are very common among children. The pattern of ENT disorders varies from community to hospital depending upon the demographic, socioeconomic and health facilities available in that particular region. The objective of the study was to evaluate and determine the hospital based prevalence of disorders of Ear, Nose and Throat among children. Methods: A prospective cross-sectional study was conducted in department of KIST Medical College and Teaching Hospital during the period of 1 year from 15th June 2021 to 15th June 2022. 320 patients attending the ENT outpatients during the study period were enrolled in the study. Informed consent was taken from patient and attendant. Diagnosis was made on the basis of history and clinical examination. Results were expressed in numbers and percentage. Results: Among the 320 (3.66%) respondents (58.7%) were Males and (42.2%) were Females. Most of the children belonged to age group 0-5 years (56.25%), were living in Nuclear family (73.4%), belong to Middle upper middle class of family (43.1%). The most common ENT disorders were ear wax (32.5%) among otological disorders, pharyngitis (6.9%) among throat disorders and rhinitis (6.6%) among nasal disorders. Conclusions: The study revealed ear wax, pharyngitis and rhinitis were the most common ENT related disorders in our area. We can improve the rate of prevalence of ENT disorders by firstly raising awareness among people and then taking further steps to improve education and health system.

Pattern and awareness of complementary and alternative medicine usage for otorhinolaryngological problems among residents in Ekiti State.

The use of complementary and alternative medicine (CAM) in the treatment of various ailments globally has called for more research. This study aimed to draw the attention of the stakeholders to the prevalence, pattern and awareness of CAM usage in otorhinolaryngological ailments and the need to safeguard the health of CAM users in Ekiti state, south - west Nigeria. This is a cross sectional descriptive study carried out over a 12-month period (January to December, 2019) among consented patients that attended ear, nose, and Throat (ENT) clinics in two tertiary health institutions in Ekiti state. All the participants are aged 18 years and above. A self-administered semi structured questionnaire was used to collect data from our respondents. A total of 148 respondents were analyzed comprising of 56 (37.8%) males and 92 (62.2%) females given a male to female ratio of 1:1.6. Their age ranged from 20-79 years with a mean of 48.03 ± 15.11 SD. The highest response was in the age group 40-49 years representing 30.4% of the respondents. About half (51.4%) of our respondents were aware of the use of CAM for throat-related conditions. Few of the respondents (18.9%) are currently using CAM. About 33.1% of our respondents were satisfied with CAM. Only 4 (2.7%) of them experienced side effects to the use of CAM. For ear-related problems, Anointing/Olive (Olea europaea) oil was most commonly used in 34.5% of our respondents; Effinrin (Ocimum gratissimum), a local herb was commonly used in 29.7% for nose and local gin in 37.2% of our respondents for throat problems. Majority of them 44 (29.7%) got information about the various agents used through Vendors/traditional health practitioner. This study showed that the prevalent of CAM usage in ORL is quite low in our setting, which represent about one-fifth of the respondents. Although respondents claimed that the system was efficacious, awareness to its usage was very low and there was no evidence to prove that the diagnosis were known before using CAM. The use of Orthodox method in treating Otorhinolaryngological ailments is still the best. We therefore recommend empirical studies on CAM in future.

ENT symptoms of mask-wearing in the coronavirus disease 2019 era.

Analysis of the otorhinolaryngological problems caused by mask-wearing in the coronavirus disease 2019 era. A survey with 26 questions was sent by e-mail to 576 individuals. The most frequently worn masks were three-layer surgical ear loop masks (n = 434, 80.1 per cent), followed by N95 or filtering facepiece code 2 masks (n = 58, 10.7 per cent), and cloth masks (n = 50, 9.2 per cent). The most bothersome symptoms caused by mask-wearing were difficulty in nasal breathing (n = 227, 41.8 per cent), nasal itching and pain (n = 93, 17.2 per cent), earache (n = 88, 16.2 per cent), difficulty in expressing oneself (n = 73, 13.5 per cent), difficulty in understanding speech (n = 56, 10.3 per cent), and ear itching (n = 5, 0.9 per cent). The problems associated with mask-wearing may result in avoidance of wearing them. Thus, there is a need for new methods that will reduce the problems related to mask-wearing, to increase their use in the community.

Микробиоценоз глоточной и небных миндалин при хронической воспалительной патологии глотки у детей

Chronic tonsillitis and adenoiditis in children is one of the unsolved problems in otorhinolaryngology. There are no specific pathogens of chronic adenotonsillitis, but there are still disputes about the viral, bacterial and fungal etiology of this disease. Chronic tonsillitis is a persistent chronic inflammation of the palatine tonsils, characterized in the vast majority of patients by recurrent exacerbations in the form of sore throats and a general toxic-allergic reaction, which is a frequently realized etiological factor of many local and general diseases and a catalyst for pathological processes in the body. Adenoid vegetations are pathological hypertrophy of the pharyngeal tonsil. Chronic adenoiditis is a chronic polyethological disease, which is based on a violation of the physiological immune processes of the pharyngeal tonsil. In children, it is impossible to talk about isolated inflammation of the pharyngeal tonsil, since as a result of exposure to antigens, an immune response occurs that involves all structures of the lymphoepithelial pharyngeal ring in the process, therefore some researchers use the term “adenotonsillitis”. With a pronounced violation of the microflora in the nasopharynx and oropharynx, the body's resistance to pathogenic microorganisms decreases, as a result, decay products and toxins lead to damage to the vascular endothelium, disrupt their permeability and, penetrating through the epithelial barrier, contribute to the development of chronic intoxication and sensitization of the body.

A Comparative Study of Using Collagen Patch or Fat Plug in Myringoplasty for Small Tympanic Membrane Perforations.

One of the most common problems in otorhinolaryngology is perforation of tympanic membrane. Although many small perforations heal spontaneously over time, some may remain persistent due to infection or some other causes. In the past years so many grafts have been used with good success rate. In this prospective study of 60 patients with small tympanic membrane perforations, we have compared newer biomaterial collagen patch and conventional fat plug as office procedures in treatment. According to our study, both groups had a significantly equal success rates & the rate of healing & complete closure at the end of 1 & 2months follow up. The hearing improvement in A-B gap during follow up of both groups were compared with pre-op A-B gap & showed a significant p value. This showed that both collagen patch & fat plug groups had a significant improvement in hearing following procedure. In our study quadrant of perforation does not correlate with the amount of hearing & healing rates were comparatively better in anterior quadrant than posterior quadrant. Infective causes were more & the failure rates were also high for such cause in both groups.

ENT and Head and Neck problems in geriatric population –A review

Ageing is a natural biological property of all living beings. There is an estimated 120 crore population around the world currently over the age of 65 years, it is also estimated that half of the world’s population would be in geriatric group by year 2050. Developed nations have about 30% of their population in geriatric age group. In India 10% of population belong to geriatric age, even though it comparatively low with other nations the numbers are huge due to population size. Special senses such as hearing and smell are impaired along with ageing body. Other otorhinolaryngological problems are also common due to degenerative changes in head and neck region. Cosmetic problems are a concern too due to the ever increasing zeal for youthfulness in modern society. We review some of the common problems faced in the elderly. Keywords: Gerontology head and neck otorhinolaryngology ageing.

Spreader Graft for Severe Deviation of Nasal Septum with Obstruction of the Internal Nasal Valve: Clinical and Functional Results.

Difficulty in nasal ventilation is one of the most frequently occurring problems in otorhinolaryngology and its correct diagnosis is the key step to solve it. The dysfunctions in the valve area are a frequent cause of chronic nasal obstruction, though commonly ignored. The objective of the study is to analyze the clinical and functional outcomes in a group of patients with septal deviations and valve compromise treated with spreader graft with endonasal approach. Thirty-five patients with septal deviation with compromise of the internal nasal valve (INV; area II of Cottle), treated with spreader graft and a minimum follow-up of 12 months, were included for analysis. Patients were evaluated with video nasosinusal endoscopy, photography, the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire, and rhinomanometry (RM). Postoperative complications were recorded. The results obtained in the pre- and postoperative NOSE scores showed significant differences (p = 0.001), as also in pre- and postoperative RM tests (p < 0.001). Two complications were reported in the 35 patients; thus the complication rate in our sample was 6%. The use of spreader grafts, with endonasal approach, as nasal septum's tutors improved perpendicular septal deviations with compromise of the INV (area II), reaching an effective functional improvement in the nasal airway, with low rate of complications.

Prevalence of ear, nose and throat disorders in children at government district hospital Vizianagaram

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Ear, nose and throat (ENT) problems are very common among the children, there is a lack of data on paediatric otorhinolaryngology from various Indian populations. This study was conducted to determine the hospital based prevalence of ENT disorders in paediatric population.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A record based, retrospective study conducted at government district Hospital, Vizianagaram, Andhra Pradesh, India. 1818 children between the ages of 0-15, attending the ENT department in our hospital were included in the study. General demographic details taken, and examination for common ENT complaints and disorders was taken for all patients. Otoscopy for ear examination for ear perforation and ear discharges. Anterior rhinoscopy for nasal discharge and airway obstruction. Throat examination was performed for any sign of tonsillitis or pharyngitis and adenoids. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; ENT diseases in our study population were found to be more common among male children (57.97%). Majority of the paediatric patients belonged to age group 5-14 years (65.7%), were from lower socioeconomic status (57.53%), living in nuclear family (62.81%) and had illiterate mothers (68.5%). Diseases of ear system (44%) were the most common group of ENT problems among the paediatric population, followed by nasal (30.9%) and throat (25.1%) disorders. The most common ENT disorders were otitis media (22.1%), tonsillitis (11.66%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study provides basic information of the prevalent disorders in ENT in our area suggests that otitis media, tonsillitis and rhinitis are the most common otorhinolaryngological problems in paediatric population visiting the ENT Department of this hospital and contribute significantly to paediatric morbidity.&lt;/p&gt;

Наблюдение острой кохлеовестибулопатии вертебро-базилярного генеза на фоне гипертонического криза

Cochleovestibular disorders are one of the urgent problems in otorhinolaryngology, due to the high incidence and insufficient efficacy of treatment. According to some researchers, cochleovestibular disorders in most cases are of vascular nature (73.0%), which is one of the reasons of the increase in the number of patients. We present a clinical case of acute cochleovestibulopathy of vertebro-basilar genesis, in the form of a momentary acute circulatory disorder in the inner ear and cervical positional vertigo associated with the hypertensive crisis. A female patient B., 61 years old,, visited the ENT Department of Karachay-Cherkess Republican Clinical Hospital with the complaints of acute hearing impairment in the left ear, noise in the ear, pain in the neck and short-term attacks of systemic rotational vertigo, accompanied by nausea when turning the head to the left and throwing it back. The otoneurological examination revealed the symptoms of left-side peripheral cochleovestibular syndrome: profound deafness, reduction of vestibular excitability on the left. De Klein test revealed right fine, binocular, associated, fast, horizontal-rotary degree 2 nystagmus. This clinical case is unusual because atherosclerotic lesion of the right vertebral artery and hypoplasia of the left vertebral artery in combination with arterial hypertension initiated a momentary occurrence of acute circulatory disorders in the inner ear and cervical positional vertigo.

Manifestations of pain symptoms in reduced occlusion

This article presents the analysis of the relevant literature highlighting the mechanisms of the development of malocclusion and pain symptom at the reduced occlusal vertical dimension. In this case, the key complaint presented by patients is permanent steady pain described as dull, stabbing, or compressing by its character. Most often, the pain is localized within the paratoid-masticatory area as well as buccal, temporal and frontal areas, and irradiates to the upper and lower jaw or the teeth that often leads to performing unnecessary dental manipulations; to the region of the temporomandibular joint (TMJ); to the ear that sometimes is accompanied with fullness and tingling in the ears. In some cases this pain can irradiate to the hard palate and tongue. Many patients note the growing intensity of pain when chewing. Some patients experience episodic increase in pain when there are pain attacks described as compressing or stabing in the background of steady dull pain. The pain gets more intense even at the slightest movements of the head, lower jaw, or when speaking. The duration of the pain attack is approximately 20–30 minutes. A few minutes before the onset of the attack, all patients notice the emergence of somes forerunning symptoms, e.g. hyperlsalivation, paresthesia, toothache. The attacks can be provoked by conversation, overcooling, and emotional tension. It has been experimentally proven that a prolonged muscle contraction, which is often observed during emotional stress, can cause pain in the regions mentioned above. But whether will it arise or not and to what extent, it depends on the state of adaptive capacity of the body and dentofacial system. When the adaptive capacity of the body and the dentofacial system as its part are weakened, the local background for the occurrence of pain symptoms in the maxillofacial area may be: affective states (depression, anxiety), prolonged chewing load, and prolonged neck muscle tension during dental manipulations.&#x0D; Among the local factors that can cause pain, malocclusions rank the leading place. For example, a hyperbalancing contact is a sign of impaired muscle activity and coordination during the maximal closure of teeth in the lateral position of the mandible, and occlusal contacts on the balancing side affect the distribution of muscle activity during parafunctional closure, and this redistribution can impact on the temporomandibular joint (Andres K. H. et al.).&#x0D; Occlusion abnormalities may result from reduced occlusal vertical dimension, deformation of the dentitions caused by periodontal disease, partial loss of teeth, pathological tooth wearing, as well as due to improperly inserted fillings, unfit inlays, onlays, crowns.&#x0D; Reduced occlusal vertical dimension can also cause otalgia and some other otorhinolaryngological problems, pathogenesis of which is quite debatable and controversial in current literature. J. S. Costen considered hearing loss, tingling and other ear symptoms are associated with pressure produced by the head of the mandible joint onto the auditory tube. Reducing the vertical occlusal dimension results in increasing pressure of the head of the mandible joint onto the subtle bone arch of the articular fossa, which separates the cavity of the joint from the dura mater; this can trigger dull pain in the spine.&#x0D; It is important to remember that pain is a symptom that most often makes patients to search for a dental care. Pain is one of the first clinical manifestations of the body decompensation. Patients with TMJ dysfunction who experience the pain symptom is to a greater or lesser extent make up a group of patients who require a special integrated approach in their treatment.

The possibility of using bacteriophages in otolaryngology

The treatment of infectious diseases in the context of the steady increase in the number of microorganisms that are resistant to antibiotics is one of the most acute problems in otorhinolaryngology. This explains the raise interest in a fundamentally new rational treatment strategy of infections both in Russia and around the world - the use of bacteriophages. These drugs have proven efficacy against antibiotic-resistant strains of bacteria, do not cause toxic and allergic reactions, and have no contraindications to use.

Nasal septal deviation with obstructive symptoms: Association found with asthma but not with other general health problems.

Nasal septal deviation (NSD) is a very common deformity. Because it may induce chronic upper airway obstruction in the nose, clinicians encounter some patients who have concerns about whether this can be a risk factor for general health. However, the influence of NSD on general health has rarely been studied. To determine associations between NSD, especially NSD with nasal obstructive symptom, and general health problems in an adult Korean population. This nationwide study analyzed data from the Korea National Health and Nutritional Examination Survey, 2008-2009. NSD was evaluated by using a nasal endoscope, and a nasal obstructive symptom was assessed via individual interviews. The survey also investigated general health problems, such as medical comorbidity, mental health status, and quality of life. Medical conditions included neurocardiovascular, respiratory, metabolic, musculoskeletal, gastrointestinal, and malignant diseases. To eliminate the effect of combined nasal problems in otorhinolaryngology, subjects with rhinosinusitis and allergic rhinitis were excluded. This study focused on obstructive NSD, which is defined as an anatomic NSD with a chronic nasal obstructive symptom. We enrolled 8865 participants, and the prevalence of NSD was 44.8%. No general health problems showed a significant association with NSD. However, the prevalence of NSD with an obstructive symptom was 2.1%. Obstructive NSD had no association with all the general health problems, except asthma. A significant association was found between obstructive NSD and asthma (odds ratio 2.648 [95% confidence interval, 1.211-5.791]). Among various general health problems, our study found that NSD was associated with asthma only when NSD was accompanied by a chronic nasal obstructive symptom.

Hearing in school-aged children with trisomy 21 - results of a longitudinal cohort study in children identified at birth.

To report the prevalence of hearing problems and the hearing sequelae in school-aged children with trisomy 21 in a longitudinal study. All children with trisomy 21 were identified via schools, community-based child development centres, general practitioners, or the universal newborn hearing screen. Audiological data and otorhinolaryngological problems were prospectively entered in to the Audiological Surveillance Programme database from each visit. Retrospective review of the Audiological Surveillance Programme database in the Glasgow area (United Kingdom) of all children reviewed between 2004 and 2012. All pre-teenaged children with trisomy 21 of school age (aged 5-12 years old). Hearing thresholds, aetiology of hearing loss and management of hearing loss was determined for the cohort of children. A total of 102 children were included. Fifty-four had normal hearing. Twenty-six had fluctuating otitis media with effusion; five had hearing in normal limits, six were managed with hearing aids, fourteen were managed conservatively, and one had ventilation tube insertion. Fifteen had persistent otitis media with effusion; four had ventilation tube insertion; and nine were managed with hearing aids. Seven had mixed hearing loss with four required hearing aids. Otitis media with effusion was the commonest cause of hearing impairment; effusions may fluctuate through the pre-teenaged years, and thus, hearing aids are beneficial. Ventilation tube insertion and bone-conducting hearing aids were useful when ear-level hearing aids were not tolerated. Mixed hearing loss occurred in later years as sensorineural hearing loss developed on a background of otitis media with effusion.

Imaging findings of mucopolysaccharidoses: a pictorial review

IntroductionMucopolysaccharidosis (MPS) represent a heterogeneous group of inheritable lysosomal storage diseases in which the accumulation of undegraded glycosaminoglycans (GAGs) leads to progressive damage of affected tissues. The typical symptoms include organomegaly, dysostosis multiplex, mental retardation and developmental delay. Definitive diagnosis is usually possible through enzymatic assays of the defective enzyme in cultured fibroblasts or leukocytes.Imaging findingsRadiological and neuroradiological findings are reported. The most important neuroradiological features include abnormal signal intensity in the white matter, dilatation of periventricular spaces, widening of cortical sulci, brain atrophy, enlargement of extraventricular spaces and spinal cord compression. With reference to the skeletal system, most important radiological findings include multiplex dysostosis, which is represented by several bone malformations found in the skull, hands, legs, arms and column. The abnormal storage of GAGs leads to liver and spleen enlargement; it also damages cartilage layers and synovial recesses in the joints.ConclusionThe aim of this pictorial essay is to describe the imaging findings of MPS, represented by skeletal and neurological features; skeletal X-ray and MR allow an assessment of the severity of disease, to plan medical and surgical therapy and to evaluate response to treatment.Teaching Points • To describe the imaging findings common to different types of MPS. • To describe multiplex dysostosis encountered in the axial and appendicular skeleton. • To evaluate neuroradiological features of MPS, including brain abnormal signal intensity and atrophy. • To evaluate important otorhinolaryngological problems, such as otitis media and airways obstruction.

Ear, Nose and Throat disorders in paediatric patients at a rural hospital in India

Background There is a lack of data on paediatric otorhinolaryngology from various Indian populations. This study was undertaken to determine the hospital prevalence of ENT disorders in paediatric population and their relationship with sociodemographic factors in a rural tertiary care hospital in India. Method A record based, retrospective study conducted at Rural Medical College and Pravara Rural Hospital, Loni which provides tertiary level health care facilities in western Maharashtra, India. The entire paediatric patients reporting to the Outpatient Department of ENT (Ear Nose Throat) during the calendar year 2009 was eligible for inclusion. Results ENT diseases in our study population were found to be more common among male children (53.2%). Majority of the paediatric patients belonged to age group 5-14 years (66.3%), were from lower socioeconomic status (61.2%), living in nuclear family (71.3%) and had illiterate mothers (70.8%). Diseases of auditory system (57.3%) were the most common group of ENT problems among the paediatric population, followed by pharyngoesophageal (27.4%) and nasal (15.3%) disorders. The most common ear, nose and throat disorders were otitis media (18.25%), rhinitis (5.8%) and tonsillitis (11.7%) respectively. Conclusion The study suggests that otitis media, tonsillitis and rhinitis are the most common otorhinolaryngological problems in paediatric population visiting the ENT department of this hospital and contribute significantly to paediatric morbidity. The results from this study cannot be applied to the community as prevalence of these morbidities is likely to be even higher in the general population.

Modern management of bleeding disorders and haemorrhage in otorhinolaryngology

Bleeding disorders and haemorrhages are recognized as common and serious problems in otorhinolaryngology. Over the past decade a number of innovative technologies and therapeutical options have been established to improve the management of them. The aim of this paper is to present diagnostical and therapeutical concepts proved to be medically effective and economically acceptable and to review the international literature. Bleeding disorders observed over a period of 10 years were analysed retrospectively to determine their prevalence and causes in otorhinolaryngology. Selected cases were used to illustrate both the efficacy and the limits of modern therapeutical options. A medico-economical evaluation of preoperative hemostaseological tests was carried out. Activated partial thromboplastin time (aPTT), Quick's prothrombin time combined with a detailed bleeding history were found to be optimal parameters to screen most of the haemostaseological defects. The incidence and severity of perioperative diffuse haemorrhages could significantly be reduced by routineous use of modern anesthesiological procedures, like controlled hypotension, total intravenous anesthesia (TIVA) and augmented ventilation techniques. Advances in interventional radiology reduced the risk of embolization of hypervascularized tumors and led to increasing application in recurrent epistaxis. A new generation of endoscopes combined with different laser techniques made the surgical treatment of hemorrhage more precise, increased the comfortability for the bleeding patient and were helpfull to decrease the length of stay and blood transfusion rates. Prevention and treatment of diffuse haemorrhages located within the craniocervical region can currently be optimized by an interdisciplinary dialog enrolling first of all the haemostaseologist and the anesthesiologist. Nowadays, close cooperation with the interventional radiologist is mandatory in the modern treatment of hypervascular lesions and vascular malformations. Moreover, it is necessary in emergency when otolaryngological measures faile to arrest bleedings from arterial site. Neither new techniques nor innovative strategies will be capable to compensate the experience and careful otolaryngologist.

Otorhinolaryngological problems occurring within the intensive care unit.

An overview of common otorhinolaryngological (ORL) problems and procedures in the intensive care unit (ICU) is presented. Diagnostic, management, and treatment aspects of some conditions are discussed with emphasis on the potential difficulties encountered in the ICU. Approach recommendations are outlined as well as a list of required basic equipment. Otorhinolaryngology should be included in intensive care continuing medical education programs.