Throat Surgery Research Articles

Effects of Intraoperative Ketamine on Post-Operative Recovery in Obstructive Sleep Apnea Patients: A Case-Control Study.

ObjectiveTo evaluate the post-operative outcomes of patients with obstructive sleep apnea (OSA) given intraoperative ketamine.Design: case-control studyA total of 574 patients (287 received ketamine and 287 were matched controls) diagnosed with OSA and body mass index (BMI) > 30 who received general anesthesia were included in this study. Patients given intraoperative ketamine were matched (1:1) with those who did not receive ketamine for age, gender, BMI, ethnicity, anesthesia time, intraoperative fentanyl dose, ketamine dose, and surgery type. A sub-analysis was performed based on the dose of ketamine administered and also on the surgery type. Measured outcomes include post-operative pain scores, post-operative opioid requirements, respiratory status, oxygen use, and duration post-operatively.ResultsIntraoperative ketamine use did not decrease pain scores or post-operative opioid use when compared with the control (no intraoperative ketamine) group. Patients who received high-dose ketamine had significantly higher post-operative pain scores (p=0.048) while in the post-anesthesia care unit (PACU) and required supplemental oxygen for a longer period of time (p = 0.030), pain scores were not significant for patients who underwent orthopedic/spine procedures (p = 0.074), and high-dose ketamine group patients who underwent orthopedic/spine surgery required significantly more opioids in the PACU (p = 0.031). Among patients who received low-dose ketamine, those who underwent head, ear, nose, and throat surgery required significantly more opioids in PACU (p = 0.022).ConclusionsLow-dose intraoperative ketamine did not decrease pain scores or post-operative opioid use significantly and did not improve standard respiratory recovery parameters for OSA patients after surgery. Neither low- nor high-dose ketamine demonstrated the anticipated benefits of low pain scores and reduced post-operative opioid use. These outcomes will differ depending on the surgery type and dose of ketamine used.

Lessons learnt from the first dual-specialty conference in oral and maxillofacial surgery led by medical students.

There remains limited formal teaching and placements in oral and maxillofacial surgery (OMFS) in medical schools. OMFS incorporates surgical techniques and attends to conditions that overlap with specialties such as plastic, and ear, nose, and throat (ENT) surgery. With an aim to introduce medical undergraduates to OMFS and promote links to clinical OMFS departments, we hereby report the successful organisation and impact of a locally-arranged, undergraduate, dual-specialty conference.

A model to predict postoperative complications for otorhinolaryngology and maxillofacial surgery procedures in elderly patients.

All kinds of ear, nose, and throat and maxillofacial surgery (ENT/MFS) procedures are being increasingly performed in the elderly although old age is a major risk factor for increased postoperative complications. With only scarce evidence on the topic, surgeons are asked to critically evaluate their procedures' indications and outcomes to balance the treatment risks and benefits. Our primary aim was to identify predictive factors for surgical outcomes in this setting and to create a predictive model for a tailored risk assessment. We analyzed a case series of 435 patients from an institutional clinical database at our academic tertiary care center. Multivariate logistic regression was used to identify all possible covariates and nomograms using stepwise backward method were generated. The performance was assessed by calibration curves and c-index. Overall complication rate was 18.3% within the first 30days and the need for re-intervention was 5.9%. For those under general anesthesia, we identified specific risk factors and developed three risk-predicting models of overall, early, and late complications. All of the nomograms showed satisfactory accuracy with a c-index of 0.83, 0.75, 0.86, and 0.82, respectively. Using clinical preoperative variables, we constructed a model for predicting major adverse events in ENT/MFS patients. In our experience, patients over 65 showed a non-negligible risk for postoperative complications depending on several factors. Such tools might help in decision-making, by increasing the risk-awareness of clinicians, to better address peri-operative and post-operative care of these patients.

Hubungan Tonsilektomi dengan Umur Keluhan Utama dan Ukuran Tonsil pada Pasien Tonsilitis Kronik

Chronic tonsillitis is a recurring infection that most often occurs in the throat, especially in children and adolescents. Tonsillectomy is one type of Ear Nose Throat (ENT) surgery that is most often performed on children, adolescents and adults. Tonsillectomy is also a procedure that can be done if there is a chronic infection or a recurring infection. Factors that can affect tonsillectomy are age, major complaints and size of the tonsils. This study was conducted to determine the relationship of tonsillectomy with age, major complaints and the size of tonsils in chronic tonsillitis patients in RSPBA of Lampung city in 2018-2019. This study uses cross-sectional, quantitative, analytic methods with secondary tonsillitis data collection. Sampling uses a total sampling technique. Data collection was done by recording data in the form of major complaints, age and size of the tonsils and analyzed using the chi-square test. The results showed that 109 tonsillitis patients showed that the majority of tonsillitis patients were group: age ≤ 18 years as many as 73 people, tonsillectomy was 66 people (90.4%), main complaints >1 were 90 people, tonsillectomy was 83 people (83 people) 92.2%) and T3-T4 tonsil size of 70 people, with tonsillectomy of 65 people (92.2%). The results also showed that there was a relationship between tonsillectomy between age (p = 0.01, OR = 3.626), main complaints (p = 0.00, OR = 13.175), tonsil size (p = 0.00, OR = 5.778) in chronic tonsilits patients at RSPBA Bandar Lampung in 2018-2019. This study concluded that there was a significant relationship between tonsillectomy with age, major complaints and the size of tonsils in chronic tonsillitis patients in Bandar Lampung RSPBA 2018-2019 with a p-value <0.05.

A Comparative Study to Ascertain the Efficacy of Palonosetron, Granisetron and Metoclopramide in Preventing Post-Operative Nausea and Vomiting in Patients Undergoing General Anaesthesia for Ear, Nose and Throat Surgeries

Postoperative nausea and vomiting (PONV) can be a very distressing side effect following general anaesthesia. Patients and health care professionals report the avoidance of PONV is of equal or sometimes even greater concern than avoidance of postoperative pain.1 It can result in increased morbidity, delay in hospital discharge and unexpected hospital re-admission, thereby increasing the total medical costs2. Moreover, PONV has been a major cause of decreased patient satisfaction3. There are several physiologic complications of nausea and vomiting that are of concern to the anaesthesiologist. Some of them being visceral wound dehiscence, electrolyte disorders, raised venous pressure leading to bleeding, rise in intraocular and intracranial tension and aspiration pneumonia especially in the sedated post-operative patient.

A Near-Peer Teaching Module to Supplement Current Undergraduate Teaching in ENT Surgery.

Near-peer teaching (NPT) has been successfully used in other medical specialties but not in ear, nose and throat surgery (ENT). Historically, undergraduates receive limited ENT exposure and subsequently report low confidence in ENT competencies. This has been a posited cause of high referral rates to the specialty. This study aimed to see if NPT could be implemented as an adjunct to traditional ENT teaching. Learners received a short NPT module that was focused on clinical ENT. Pre- and post-module questionnaires collected data on students' confidence and knowledge. One hundred twenty-five undergraduate learners received the intervention. There was a significant percentage increase in both confidence (24.2%, p = < 0.001) and knowledge (35.9%, p = < 0.001) of learners. In a supervised setting, NPT could be a valuable adjunct to traditional undergraduate ENT education.

Non-technical skills and otolaryngology: systematic review.

This study aimed to assess the published literature on non-technical skills in otolaryngology surgery and examine the applicability of any research to others' practice, and to explore how the published literature can identify areas for further development and guide future research. A systematic review was conducted using the following key words: 'otolaryngology', 'otorhinolaryngology', 'ENT', 'ENT surgery', 'ear, nose and throat surgery', 'head and neck surgery', 'thyroid surgery', 'parathyroid surgery', 'otology', 'rhinology', 'laryngology' 'skull base surgery', 'airway surgery', 'non-technical skills', 'non technical skills for surgeons', 'NOTSS', 'behavioural markers' and 'behavioural assessment tool'. Three publications were included in the review - 1 randomised, controlled trial and 2 cohort studies - involving 78 participants. All were simulation-based studies involving training otolaryngology surgeons. Little research has been undertaken on non-technical skills in otolaryngology. Training surgeons' non-technical skill levels are similar across every tested aspect. The research already performed can guide further studies, particularly amongst non-training otolaryngology surgeons and in both emergency and elective non-simulated environments.

The Effect of Astaxanthin Administration on Plasma Levels of Tumor Necrosis Factor-? and Palatine Tonsil Swab in Chronic Tonsillitis Patients

Background: Chronic tonsillitis is chronic inflammation of the palatine tonsils which can be caused by thepresence of free radicals that stimulate the formation of pro-inflammatory cytokines such as Tumor NecrosisFactor-? (TNF-?) and interleukin-6 (Il-6). Astaxanthin as an antioxidant and anti-inflammatory is thought toreduce levels of proinflammatory cytokines.Aim: To determine plasma levels of TNF-? and palatine tonsill smears in patients with chronic tonsillitisbefore and after administration of astaxanthin.Method: Research with clinical trial design. Thirty-one subjects who met the inclusion and exclusioncriteria in the Ear, Nose, Throat, Head and Neck Surgery clinic in Wahidin Sudirohusodo Hospital andNetwork Hospital were given astaxanthin 4 mg/day for 14 days. Plasma TNF-? levels and palatine tonsilesmears were examined before and after administration of astaxanthin. Data were analyzed using SPSS 25thversion. The statistical tests used Paired-t test and Independent-t test.Results: Thirty-one subjects can be followed until the end of the study. Astaxanthin 4 mg per day for 14 dayscan reduce plasma TNF-? levels and palatine tonsil swab of patients with chronic tonsillitis (p &lt;0.05), andthere is no significant difference in TNF-? levels between plasma and palatine tonsil swab both before andafter administration astaxanthin (p&gt; 0.05).Conclusion: Astaxanthin can reduce plasma TNF-? levels and palatine tonsil swab in chronic tonsillitispatients.

Postoperative Functional and Cosmetic Satisfaction among Subjects Undergoing Open Versus Endonasal Septorhinoplasty: Five Years' Experience from an Open-label Study at a Tertiary Care Center in Oman.

ObjectivesWe sought to compare functional and cosmetic satisfaction among male and female patients undergoing open and closed septorhinoplasty within sub-groups of indications for the surgery at a tertiary care hospital in Oman.MethodsWe conducted a prospective study in the ear, nose, and throat surgery department at Sultan Qaboos University Hospital from 2010 to 2015. All patients aged above 17 years, without dysmorphic pathologies, and due to be operated through open or endonasal septorhinoplasty based on the appropriate indications (functional or cosmetic or functional and cosmetic), were included in the study.ResultsOut of 215 patients who underwent septorhinoplasty, 30 were lost to follow-up. One-hundred and eighty-five patients (124 males and 61 females) available for postoperative assessment had been allocated to septorhinoplasty by the endonasal approach (n = 89; 59 males and 30 females) or open approach (n = 96; 65 males and 31 females) based on their indications for surgery: functional (n = 98; 64 males and 34 females); cosmetic (n = 39; 23 males and 16 females); and both functional and cosmetic (n = 48; 37 males and 11 females). Sex-wise distribution across different age groups for the specific surgical technique based on indication for surgery did not show any significant differences within any of the respective sub-groups. Both sexes reported no significant difference in satisfaction per their scores on the functional satisfaction scale post open or endonasal intervention. However, in their cosmetic satisfaction scale scores, a significantly higher proportion of males within the functional indication for surgery subgroup (90.9%) expressed satisfaction with the open surgical approach than the 71.0% males operated by the endonasal approach (p = 0.041).ConclusionsMales undergoing septorhinoplasty for functional indications expressed significant satisfaction with the open surgical approach compared with the endonasal approach on the cosmetic satisfaction scale. This study could accrue only 185 patients during the five-year study period and hence was unable to generate any significant evidence to prove any differences in postoperative functional and cosmetic satisfaction outcomes within sub-groups based on other indications for surgery for males and females separately.

Design and Kinematics Analysis of a Continuum Throat Surgery Robot

A cable-driven continuum throat surgery robot is designed in this paper, which is a new type of bionic robot with softness and flexibility. Throat surgery robot in the market has the disadvantage of large-scale wound and discomfort, robot in this can solve these problem. Firstly, the joint of the robot is modularized by simulating the skeleton of the snake, and the modules are connected by spherical joints to simulate the high flexibility of the snake. Secondly, each part of the robot is controlled by three cables to control the bending motion in the pitch and yaw directions. Lastly, the kinematics analysis is carried out by the D-H method, including the mapping of the driving space, joint space and operation space of the joint module. According to the entity we make, it is approved that the robot has the advantages of small structural size, high positioning accuracy, and strong space flexibility for that the structure of the snake robot is integrated with the drive of the continuous robot. It is ideal for transoral throat surgery, and the operation is performed through the natural cavity to ensure the accuracy and safety of the operation, and the postoperative recovery is also faster.

Pre-operative transnasal endoscopy as a predictor of difficult airway: A prospective cohort study.

Consequences of failed endotracheal intubation can be catastrophic and predicting difficulty is therefore a critical issue. There is no consensus on the best way to predict difficulty. To evaluate the role of transnasal flexible endoscopic laryngoscopy (TFEL), a minimally invasive procedure, in the prediction of difficult intubation. Prospective cohort study. San Raffaele Hospital, Milan, a tertiary university hospital. One hundred and sixty nine adults scheduled for elective ear, nose and throat surgery under general anaesthesia with pre-operative TFEL. In addition to routine pre-operative evaluation by an anaesthesiologist, glottis exposure during TFEL was assessed with a scoring system similar to the modified Cormack-Lehane (MCL). The extent to which TFEL improves the prediction of difficult direct laryngoscopy, measured with the MCL score, and of difficult intubation, measured with the intubation difficulty scale score. When added to bedside evaluation, TFEL performed during tongue protrusion significantly (P = 0.005) improved the prediction of MCL. The area under the receiver operating characteristics curve was 0.75 [95% confidence interval (CI) 0.67 to 0.83] vs. 0.65 (95% CI 0.58 to 0.74). For the intubation difficulty scale (P = 0.049), the area under the receiver operating characteristics curve was 0.70 (95% CI 0.61 to 0.80) vs. 0.66 (95% CI 0.58 to 0.74). TFEL is a useful tool in predicting difficult intubation, improving predictability of routine bedside evaluation. ClinicalTrials.gov identifier: NCT02671877.

Toxic Epidermal Necrolysis and Steven-Johnson Syndrome: A Comprehensive Review.

Significance: Toxic epidermal necrolysis (TEN) and Steven-Johnson syndrome (SJS) are potentially fatal acute mucocutaneous vesiculobullous disorders. Evidence to date suggests that outcomes for patients with both TEN and SJS are largely dependent on stopping the causative agent, followed by supportive care and appropriate wound management in a specialized burns unit. These are life-threatening conditions characterized by widespread full-thickness cutaneous and mucosal necrosis. This article outlines the approach to holistic management of such patients, in a specialized unit, highlighting various practical aspects of wound care to prevent complications such as infection, mucosal and adhesions, and ocular scaring. Recent Advances: There is improved understanding of pain and morbidity with regard to the type and frequency of dressing changes. More modern dressings, such as nanocrystalline, are currently favored as they may be kept in situ for longer periods. The most recent evidence on systemic agents, such as corticosteroids and cyclosporine, and novel treatments, are also discussed. Critical Issues: Following cessation of the culprit trigger, management in a specialized burns unit is the most important management step. It is now understood that a multidisciplinary team is essential in the care of these patients. Following admission of such patients, dermatology, ear, nose, and throat surgery, ophthalmology, urology, colorectal surgery, and gynecology should all be consulted to prevent disease sequelae. Future Directions: Looking forward, research is aimed at achieving prospective data on the efficacy of systemic immunomodulating agents and dressing types. Tertiary centers with burns units should develop policies for such patients to ensure that the relevant teams are consulted promptly to avoid mucocutaneous complications.

An Evaluation of the Hybrid Model for Predicting Surgery Duration.

The degree of accuracy in surgery duration estimation directly impacts on the quality of planned surgical lists. Model selection for the prediction of surgery duration requires technical expertise and significant time and effort. The result is often a collection of viable models, the performance of which varies across different strata of the surgical population. This paper proposes a prediction framework to be used after a comprehensive model selection process has been completed for surgery duration prediction. The framework produces a partition of the surgical cases and a "hybrid model" that allocates different predictors from the collection of viable models to different parts of the surgical population. The intention is a flexible prediction process that can reassign models and adapt as surgical processes change. The framework is tested via a simulation study, and its utility is demonstrated by predicting surgery durations for Ear, Nose and Throat surgeries in a New Zealand hospital. The results indicate that the hybrid model is effective, performing better than standard model selection in two of the three simulation studies, and marginally worse when the selected model was the true underlying process.

Effects of lidocaine versus fentanyl on attenuation of hemodynamic responses to extubation after ear, nose and throat surgery in a resource limited setting: A prospective observational study

BackgroundTracheal extubation, the purposeful removal of the endotracheal tube from the trachea, can be associated with detrimental hemodynamic and airway responses. Lidocaine and fentanyl are known to suppress hemodynamic responses to extubation during Ear, nose, and throat surgeries. Smooth tracheal extubation is important after Ear, nose, and throat surgeries. ObjectiveTo compare the effects of lidocaine versus fentanyl on attenuation of hemodynamic responses to extubation after ear, nose and throat surgery in a resource limited setting from January 01, 2018 to March 30, 2018. MethodsThis is a prospective cohort study recruits 74 American Society of Anesthesiologist class I and II, age between 18 and 60 patients who underwent Ear, Nose, and Throat surgeries. Unpaired T test was used to compare the mean heart rate and arterial blood pressure between lidocaine and fentanyl groups. Mann Whitney U Test was used for distribution free data. Association of categorical independent variables between two groups was analyzed using Chi Square or fisher exact test. P-values < 0.05 were considered as statistically significant with a power of 80%. ResultsThe demographic and clinical characteristics were comparable between groups. The pulse rate and mean arterial blood pressure were statistically significantly lower in fentanyl group at 1, 5, and 10 min after extubation with p values < 0.05. There was no statistically significant difference between two groups in decreasing the incidence of coughing in the Peri-extubation period with a p value of 0.857. ConclusionThe findings of our study demonstrate that fentanyl 1 μg/kg IV, administered 10 min before end of operation might be effective in attenuating hemodynamic response to tracheal extubation compared with lidocaine 1.5 mg/kg IV in patients underwent ENT surgeries.

New frontiers of nerve regeneration in ear, nose, and throat surgery

Nerve injury is common in various specialties. Apart from the traditional end-to-end direct repair in limited nerve injuries, there are many new techniques that are being investigated worldwide. At the moment, synthetic nerve grafts, called scaffolds, made by tissue-friendly materials and covered by different kinds of cells such as Schwann cells or stem cells are being tested. In order to maximize the tissue integration and accelerate the nerve regeneration, various nerve growth factors are being used as well with promising results. Otolaryngology patients will certainly benefit from most of these techniques as facial nerve, recurrent laryngeal nerve, ear hair cells, and other kinds of nerves could be generated using innovative treatments in the future. The aim of this article is to review the main advancements in ear, nose, and throat (ENT) nerve regeneration. A literature review was performed in PubMed and Medline databases using the following keywords: nerve regeneration, neuroregeneration, otolaryngology, ENT, head, and neck. A significant number of articles and reviews were found as well as trials on nerve regeneration in otolaryngology. Many different techniques are being investigated currently in order to regenerate damaged nerves. It is a very complex procedure as it requires axonal regrowth in the correct direction as well as sensory and motor function restoration to full. The gold standard nowadays remains the end-to-end primary repair; nevertheless, there are various other methods with very promising results.

The prevalence of emergence delirium and its associated factors among children at a postoperative unit: A retrospective cohort at a Middle Eastern hospital.

Background:Emergence delirium (ED) has been reported among children at a postoperative setting, which delays their recovery and exposes them to traumas. The aim of this study was to determine the prevalence of ED and its associated factors among children who underwent surgeries at a major tertiary healthcare facility in Saudi Arabia.Materials and Methods:Between March and August 2018, a retrospective cohort study was conducted based on a review of 413 medical charts of children (<14 years) who underwent an elective/nonemergency surgery and then were admitted to a Post Anesthesia Care Unit. Patient and surgery-related characteristics were analyzed as potential factors associated with ED. The anxiety level was assessed preoperatively using the Modified Yale Preoperative Anxiety Scale (four domains), while the ED was detected after surgery using the Watcha scale (child is agitated and thrashing around).Results:The leading surgery category was ear, nose, and throat surgeries [184 (44.6%)] and dental surgeries [109 (26.4%)]. Almost one-third received only general anesthesia (31.2%), while 271 (68.8%) received an additional regional block/skin infiltrate. The anxiety domains preop showed that the percentage mean score ± standard deviation of expression of emotions was 37.1 ± 21.6, apparent arousal 33.7 ± 20.4, activeness 30.1 ± 13.5, and vocalization 26.9 ± 20.3. The prevalence of ED among children who underwent surgeries during the 6-month period was 23 (6.6%). Almost 18.8% of those who received opioid analgesics (fentanyl alone) developed ED, while 12% of those who received both opioid and nonopioid analgesics (fentanyl/paracetamol) developed ED. ED was significantly associated with longer recovery duration 69.5 + 27.1 min, P = 0.007. Binary logistics regression analysis showed that participants who did not receive Precedex were adj. odds ratio = 10.3 (2.4–48.9) times more likely to develop ED, compared with those who received it, adj. P = 0.003. Lower preoperative scores of expression of emotions and higher scores of apparent arousal were significantly associated with ED, adj. P = 0.035 and adj. P = 0.023, respectively.Conclusion:ED appears to be inevitable in postoperative settings. It is crucial to address any preoperative anxiety assessment as it is associated with ED. Anxiety remains a modifiable factor that can be managed, as well as to the administration of Precedex and adjunct analgesic treatments.

Risk assessment of obstructive sleep apnea among gastroesophageal reflux disease patients in Taif, Saudi Arabia.

Background:Previous studies have reported the association between gastroesophageal reflux disease (GERD) and obstructive sleep apnea (OSA).Objectives:The aim of the present study was to assess the prevalence of GERD among Saudi population, and to determine the risk of OSA among those diagnosed with GERD in Taif city of Saudi Arabia.Materials and Methods:A cross-sectional online survey was done among 843 Saudi participants using a questionnaire by collecting demographic data, weight, height, blood group, and having a previous nose or throat surgery. The GERD questionnaire and the sleep apnea symptom index were used to determine GERD and OSA prevalence.Results:The prevalence of GERD and OSA was 17.6% and 2.4%, respectively. A significantly higher prevalence of GERD was found among males, those with age >50 years, employees and obese participants, and those having OSA. Participants with an age >50 years and males, had a significantly higher prevalence of OSA. Being a male and older age were predictors for GERD, and the presence of GERD was an independent predictors for OSA.Conclusion:Future population-based studies including a representative sample of the population should be done to confirm the revealed association between GERD and OSA. It is necessary to assess GERD in patients with OSA in clinical practice.

Comparative study of epley's and semont's maneuver in treatment of benign paroxysmal positional vertigo in a tertiary care hospital

Introduction: Benign paroxysmal positional vertigo (BPPV) is the most common cause of true vertigo resulting from displacement of otoconia into the semicircular canals. Both Epley's and Semont's maneuver have been used since decades with rewarding results. Aim: This study aims to compare the efficacy between the two methods in inducing remission of symptoms and preventing relapse. Materials and Methods: This study has been done in department of ear, nose, throat, and head and neck surgery of a rural tertiary care hospital in India with 10 month duration from April 2019 to February 2020. Sixty-six diagnosed cases of BPPV were included in the study and two groups were created. First group (A) included those 33 patients treated with Epley's and other group (B) included the rest 33 patients those had been treated by Semont's maneuver and the results compared. We excluded the patients having central or other peripheral causes of vertigo and those suffering from cervical spondilopathy. Data collected as entered into Microsoft office excel 2013 and were analyzed using SPSS 20.0 [IBM, New York, USA]. Chi-square test applied and statistical significance was set at P ≤ 0.05. Results: Both the treatments showed relief of symptom within 1st week of treatment. Thirty patients of Group A out of 33 (90.9%) o and 22 patients of group B out of 33 (67%) got relieved from symptoms. Patients followed up for 6 months post treatment for recurrence and it was found that 3 patients in group A and 6 patients in group B showed relapse of symptoms requiring further treatment. Conclusion: Both methods efficient in treating BPPV with Epley's maneuver relatively more effective than Semont's in terms of remission (statistically significant with P = 0.016 and both maneuvers gave similar results in terms of relapse.

Risk factors associated with tinnitus in 2948 Dutch survivors of childhood cancer: a Dutch LATER questionnaire study.

BackgroundTinnitus is a serious late effect of childhood cancer treatment. The aim of this study was to determine the occurrence and risk factors for tinnitus in a national cohort of childhood cancer survivors (CCS).MethodsData were collected within the national Dutch Childhood Oncology Group - Long-Term Effects after Childhood Cancer (DCOG-LATER) cohort by a self-reported health questionnaire among 5327 Dutch CCS treated between 1963 and 2002. Siblings (N = 1663) were invited to complete the same questionnaire. Relevant patient characteristics and treatment factors were obtained from the Dutch LATER database. The occurrence of tinnitus in survivors was compared to siblings. To study the effect of risk factors, multivariate logistic regression models were estimated.ResultsIn total, 2948 CCS and 1055 siblings completed the tinnitus item. Tinnitus was reported in 9.5% of survivors and in 3.7% of siblings (odds ratio [OR] 3.0, 95% confidence interval [CI] 2.9–3.1). Risk factors associated with tinnitus in CCS were total cumulative dose cisplatin ≥400 mg/m2 (OR 2.4, 95% CI 1.4–4.0), age at diagnosis (≥10 years: OR 2.1, 95% CI 1.6–2.8), cranial irradiation/total body irradiation (TBI; OR 1.9, 95% CI 1.5–2.5), and neuro/ear, nose, throat (ENT) surgery (OR 1.8, 95% CI 1.1–2.9). Fifty-one percent of CCS with tinnitus had received treatment with either cisplatin, cranial irradiation/TBI, and/or neuro/ENT surgery.ConclusionsTinnitus in CCS was present nearly 3 times more often than in siblings. Awareness in CCS previously treated with cisplatin, cranial irradiation/TBI, and/or neuro/ENT surgery is warranted. As only half of affected CCS had a history of these treatments, it seems that other factors might be associated with tinnitus occurrence in this population.

An audit of pain management at a tertiary care center

Introduction: Pain management is a vital part of postoperative treatment. Pain management in the postoperative period is based on a number of factors such as the extent of surgery, patient profile and surgeon experience, etc. The numbers of subjective scoring system were proposed to scale the severity of pain. Materials and Methods: This prospective audit was performed between November 2015 to January 2016. Pain scores were recorded in all patients underwent surgery for initial three days by numerical rating scale (NRS). Results: A total of 92 patients were included in this audit. The patients were broadly divided into the two groups: non-malignancy group and malignancy group. Pain scores were found higher in adult patients, in malignancy patients, and in patients who require wide excision. The scores were found on the lower side in the ear and throat surgery group in comparison to the nose surgery group. Discussion: Postoperative pain is an individual multi-factorial experience. Poor management is likely to increases the chances of local and systemic complications and delays in the recovery of the patients. Appropriate selection of analgesics would reduce hospital financial burden to a great extent but the side effect profile of each drug should be kept in mind.