Throat Unit Research Articles

English

The study involved 70 nasal swab collected from people suffering from sinusitis and consulted the Ear, Nose and Throat Unit in Al-Diwaniya Teaching Hospital, Iraq during the period from 12 June to 12 August 2016 with ages ranging from 0-65 years old. The results showed that the number of nasal swabs that gave fungal growth was 36/70 (51.428%); highest percentage of fungal infection was recorded in ages ranging from 11-20 years old 8(80%), followed by above 60 years old 7(70%) and lowest infection was in 51-60 years old 3(30%) when compared. A total of 43 fungal isolates were identified and the isolates belong to 7 genera comprising of Penicillium spp. with 16 isolates, Aspergillus spp. with 14 isolates (mainly A. niger= 7, A. flavus= 5 and A. fumigates= 2), Cladosporium spp. with 4 isolates, Rhizopus spp. 3 isolates, Sporothrix schenckii 3 isolates, Mucor spp. 2 isolates and Fusarium spp. 1 isolate. Penicillium spp. occurred with the highest frequency percentage of (37.209%), followed by A. niger (16.279%) and A. flavus (11.627%) with significant differences when compared with other fungi isolated in this study while the lowest percentage frequency was recorded for Fusarium spp. (2.325%). Potassium sorbate and Sodium benzoate have high inhibitory activity against the growth of all fungi studied and increases in their concentration caused corresponding increases in their percentage inhibition of fungal growth which ranged at concentration 1000 mg/L of potassium sorbate and sodium benzoate between (90.7-94.5%) and (91.2-95.8%) respectively. Key words: Antifungal, potassium sorbate, sodium benzoate, sinusitis.

Real-life study showing better control of allergic rhinitis by immunotherapy than regular pharmacotherapy

Treatment for allergic rhinitis (AR) aims at reducing the burden of allergic inflammation, either by suppression of the nasal inflammation with pharmacotherapy or by inducing tolerance via immunotherapy (IT). At present, we lack information on the comparison between the degree of symptom control in AR patients treated with IT and those on pharmacotherapy. An observational study was conducted evaluating the degree of symptom control, the total and individual nasal symptom severity and current medication use at 3 years after starting either pharmacotherapy or subcutaneous immunotherapy (SCIT) for AR. A total number of 800 patients diagnosed with AR between October 2007 and February 2010 at the Ear, Nose and Throat Unit and Allergology Clinical Department of the University Hospitals of KU Leuven, Belgium, were included. Among these patients, 120 had been started on IT at the time of their initial visit, and 680 were prescribed guideline-based pharmacotherapy. In 2013, patients were sent a questionnaire asking for the current severity of nasal symptoms using a visual analogue scale (VAS) score, duration of nasal symptoms and presence or absence of abnormal sleep, impairment of daily activities, sport, leisure, impaired functioning at work/school, troublesome symptoms, and current medication use. A VAS score for total nasal symptoms (TNS) was used to distinguish between controlled and uncontrolled AR. An overall response rate of 54%. At 3 years after the initiation of the treatment, the IT group showed lower VAS scores for TNS than the pharmacotherapy group, with lower percentages of patients having a VAS score of equal or higher than 5. The IT group consisted of more patients with mild AR than the pharmacotherapy group despite the higher percentage of polysensitization at the onset of treatment in the IT group. 18% of the IT patients met the criteria of persistent AR whereas this was 51% amongst non-IT patients. Interestingly, 70% of IT patients did not use any medical treatment for AR anymore, whereas 61% of pharmacotherapy patients were still on medical treatment. This observational study demonstrates that IT is associated with higher control of AR, reduced symptom severity and reduced medication use at 3 years after the onset of treatment. Therefore, this real-life study reinforces the clinical value of immunotherapy in allergic rhinitis.

Experience in the surgical treatment of paranasal sinus mucoceles in a university hospital

Abstract Background Mucoceles are benign cystic lesions of the paranasal sinuses. Endoscopic marsupialisation is considered the first choice of treatment, due to its low morbidity and recurrence rates. Objective To establish the number of patients with recurrence, who were diagnosed clinically or by computed tomography, and who were submitted to surgery in the Ear, Nose and Throat Unit in a tertiary university hospital. Material and methods A clinical, cross-sectional, descriptive, observational and retrospective study was conducted on patients with a mucocele diagnosis operated on in the period from January 2006 to December 2013. A descriptive statistical analysis was performed to obtain the frequencies, ratios and proportions. Measures of central tendency and dispersion were obtained. The recurrence rates of each surgical technique were compared using the Chi-squared test. Results Of the 59 patients included in the study, 39 were female and 20 were men. The most common location was in the maxillary sinus (22 patients) followed by frontoethmoidal (20 patients). There was a recurrence of 9% in those submitted to a surgical procedure. The endoscopic approach was used in 51 patients, 8 cases were combined (open plus endoscopic), and there was no open approach. There was a recurrence in 7 of 51 of patients with endoscopic surgery, and one out of 8 patients had a recurrence with a combined technique. Conclusions No statistically significant relationship was found between the type of surgery and recurrence, or between the presence or absence of a predisposing factor and recurrence.

Foreign Body Aspiration in Northern Ghana: A Review of Pediatric Patients.

Background Foreign body (FB) aspiration requires a high index of suspicion for diagnosis and prompt management to avoid morbidity and mortality. This retrospective study was conducted to review pediatric foreign body aspiration at the Ear, Nose and Throat (ENT) Unit of the Tamale Teaching Hospital (TTH). Materials and Methods The theater records of children managed for foreign body aspiration from January 2010 to December 2016 at the ENT Unit of TTH were retrieved and data summarized with respect to age, gender, indications for bronchoscopy, nature of foreign body, location of foreign body, and outcome of the bronchoscopy procedure. Results A total of 33 children were managed within the five-year study period and comprised 16 (48.5%) males and 17 (51.5%) females. The commonly aspirated FBs were groundnuts (13, 39.4%) and metallic objects (7, 21.1%). The peak incidence occurred in children aged ≤ 3 years. The foreign bodies (FBs) were commonly localized to the right (24.2%) and left (24.2%) main bronchi, respectively. One patient had emergency tracheostomy for failed bronchoscopy. Conclusion Groundnuts were the most commonly aspirated foreign body with most of the FBs localized in the bronchi.

Experiencia en el tratamiento quirúrgico de mucoceles de senos paranasales en un hospital universitario

BackgroundMucoceles are benign cystic lesions of the paranasal sinuses. Endoscopic marsupialisation is considered the first choice of treatment, due to its low morbidity and recurrence rates. ObjectiveTo establish the number of patients with recurrence, who were diagnosed clinically or by computed tomography, and who were submitted to surgery in the Ear, Nose and Throat Unit in a tertiary university hospital. Material and methodsA clinical, cross-sectional, descriptive, observational and retrospective study was conducted on patients with a mucocele diagnosis operated on in the period from January 2006 to December 2013. A descriptive statistical analysis was performed to obtain the frequencies, ratios and proportions. Measures of central tendency and dispersion were obtained. The recurrence rates of each surgical technique were compared using the Chi-squared test. ResultsOf the 59 patients included in the study, 39 were female and 20 were men. The most common location was in the maxillary sinus (22 patients) followed by frontoethmoidal (20 patients). There was a recurrence of 9% in those submitted to a surgical procedure. The endoscopic approach was used in 51 patients, 8 cases were combined (open plus endoscopic), and there was no open approach. There was a recurrence in 7 of 51 of patients with endoscopic surgery, and one out of 8 patients had a recurrence with a combined technique. ConclusionsNo statistically significant relationship was found between the type of surgery and recurrence, or between the presence or absence of a predisposing factor and recurrence.

Experience with rigid esophagoscopy in Jos, north-central Nigeria.

Esophagoscopy which may be done for either a therapeutic or diagnostic reason has remained useful in the management of esophageal diseases. This study evaluates our experience with rigid esophagoscopy with special emphasis on esophageal foreign bodies in our unit. This is a six-year (January 2000-December 2005) retrospective review of cases of rigid esophagoscopy in the Ear, Nose and Throat Unit of our center. Fifty-seven patients with ages ranging from 10 months 75 years were studied. There were 35 (61.4%) males and 22 (38.6%) females. Fifty-three of the patients (93%) had varying foreign bodies in the esophagus, 3 (5.2%) patients had carcinoma of the esophagus while 1 (1.8%) had pharyngeal pouch. The 0-10 year age group had the highest prevalence of esophageal foreign bodies (66.0%) with the middle third of the esophagus been the commonest site of impaction (58.5%). There was no fatality recorded. Rigid esophagoscopy is a relatively safe procedure in trained hands and ideal environment with the necessary facilities in place.

Post-tonsillectomy late haemorrhage: Is it a preferably night-time event?

Aim To evaluate the relationship between the incidence of late post-tonsillectomy haemorrhage and its prevalence in a definite period of the day. Study design and setting This retrospective study was carried out in the Ear Nose Throat (ENT) Unit of Giannina Gaslini Institute, Genoa, Italy on children operated for adenotonsillectomy (AT) or tonsillectomy (T) between January 2003 and February 2008. We considered in the study all the post-tonsillectomy late haemorrhages irrespective of their severity and for each case we evaluated whether they recurred in the day-time (B) (between 9.00 a.m. and 9.00 p.m.) or in the night-time (A) (between 9.00 p.m. and 9.00 a.m.). Finally we considered the number of haemorrhages per hour in the whole day. Results Out of 3306 patients undergoing elective adenotonsillectomy or tonsillectomy, post-operative late haemorrhage occurred in 59 (1.78%). We noted that 42 episodes (71.2%) occurred in the night-time and 17 (28.8%) in the day-time. The average time from the operation was 8.4 days. A statistically significant difference ( p = 0.002) was found when comparing the frequencies of night-time and day-time haemorrhages. We did not observe any significant difference in the distribution per hour of the haemorrhages. Conclusions The incidence of post-tonsillectomy late haemorrhage in our study population was 1.78%. A statistically significant difference was found between night-time and day-time haemorrhages. Even though no significant distribution of haemorrhages per hour was observed, we underline that we recorded 32 (54.2%) events in 2 periods of the day: from 10 p.m. to 1 a.m. and from 6 to 9 a.m.

Laryngeal dyspnea in relation to an interaction between acenocoumarol and topical econazole lotion

Background: Bleeding is the most serious complication of oral anticoagulant therapy used for the prevention of thromboembolic complications. Drug-drug interactions are an important concern, as they may increase drug toxicity and, in the case of anticoagulant therapies, increase the risk of hemorrhage. Case summary: An 84-year-old woman presented to the emergency department with a bilateral cervical hematoma and symptoms of upper-airway obstruction that had been increasing for 72 hours, with dyspnea and difficulty speaking developing in the previous 24 hours. Transnasal fiberoptic laryngoscopy revealed a significant laryngeal hematoma, as well as a hematoma on the floor of the mouth and in the tonsil area. Laboratory abnormalities included a prothrombin time < 10%, an international normalized ratio exceeding the laboratory limits, and an activated partial thromboplastin time >120 seconds. The patient had been receiving acenocoumarol 4 mg/d for 10 years for episodes of atrial fibrillation and recurrent deep venous thrombosis. Seventeen days earlier, she had received a prescription for topical econazole lotion 1% to be applied 3 times daily for 1 month to treat a dermatitis affecting 12% of the body surface. The patient was admitted to the intensive care unit for treatment of respiratory failure, where oxygen was delivered by face mask. The coagulation disorders were treated with prothrombin complex concentrate 30 IU/kg IV and vitamin K 1 10 mg IV, and values normalized within 36 hours. Surgical evacuation of the laryngeal hematoma was not necessary. After 48 hours, improvement in the patient's respiratory symptoms allowed transfer to the ear, nose, and throat unit, where daily endoscopic examination was performed. Aspirin was substituted for acenocoumarol, and the patient returned home after 10 days without sequelae. Based on a Naranjo score of 7, this episode was probably related to an interaction between acenocoumarol and econazole. Conclusion: This report describes a case of a probable interaction between topical econazole lotion 1% and acenocoumarol that resulted in overanticoagulation and a life-threatening laryngeal hematoma in this elderly patient.

An intensivist-led tracheostomy review team is associated with shorter decannulation time and length of stay: a prospective cohort study

IntroductionWithout specific strategies to address tracheostomy care on the wards, patients discharged from the intensive care unit (ICU) with a tracheostomy may receive suboptimal care. We formed an intensivist-led multidisciplinary team to oversee ward management of such patients. To evaluate the service, we compared outcomes for the first 3 years of the service with those in the year preceding the service.MethodsData were prospectively collected over the course of 3 years on ICU patients not under the care of the ear, nose, and throat unit who were discharged to the ward with a tracheostomy and compared with outcomes in the year preceding the introduction of the service. Principal outcomes were decannulation time, length of stay after ICU discharge, and stay of less than 43 days (upper trim point for the disease-related group [DRG] for tracheostomy). Analysis included trend by year and multivariable analysis using a Cox proportional hazards model. P values of less than 0.05 were assumed to indicate statistical significance. As this was a quality assurance project, ethics approval was not required.ResultsTwo hundred eighty patients were discharged with a tracheostomy over the course of a 4-year period: 41 in 2003, 60 in 2004, 95 in 2005, and 84 in 2006. Mean age was 61.8 (13.1) years, 176 (62.9%) were male, and mean APACHE (Acute Physiology and Chronic Health Evaluation) II score was 20.4 (6.4). Length of stay after ICU decreased over time (30 [13 to 52] versus 19 [10 to 34] days; P < 0.05 for trend), and a higher proportion of decannulated patients were discharged under the upper DRG trim point of 43 days (48% versus 66%; P < 0.05). Time to decannulation after ICU discharge decreased (14 [7 to 31] versus 7 [3 to 17] days; P < 0.01 for trend). Multivariate analysis showed that the hazard for decannulation increased by 24% (3% to 49%) per year.ConclusionAn intensivist-led tracheostomy team is associated with shorter decannulation time and length of stay which may result in financial savings for institutions.

Challenges in management of chronic suppurative otitis media in a developing country

In developing countries, the rate of complications from chronic suppurative otitis media is still high, due to factors associated with poverty. This study aimed to determine the prevalence of chronic suppurative otitis media and associated complications. We prospectively studied all patients presenting with chronic suppurative otitis media to the ear, nose and throat unit of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, over a two-year period. One hundred and sixty new cases of chronic suppurative otitis media were seen. These constituted 11.1 per cent of all new cases and 21.5 per cent of all otological cases seen. About half (51.7 per cent) of these patients were younger than 15 years. Most patients were from rural areas and had been previously managed by unlicensed, untrained practitioners. Complications were mostly seen in children. Intracranial complications were seen in 10 (6.3 per cent) cases; this was associated with a high mortality rate. This study found that, in Nigeria, a developing country, 'safe' chronic suppurative otitis media was not without serious problems. Provision of adequate health facilities may reduce such problems.

Laryngeal cancer at the Korle Bu Teaching Hospital, Accra, Ghana

Laryngeal cancer is the commonest Head and Neck cancer seen at the Ear Nose and Throat (ENT) Unit Korle-Bu Teaching Hospital. The aim of this study was to determine the number of cases of laryngeal cancer seen at the Korle Bu Teaching Hospital, establish epidemiological parameters of the disease and to outline preventive measures. One hundred and fifteen (115) patients who were managed for laryngeal cancer from 1(st) January 1998 to 31(st) December 2003 were studied retrospectively with respect to age, sex, duration of symptoms at presentation, risk factors, symptoms complex, histopathology, stage of tumor, details of treatment offered and follow up. The age range was 17-85 years with a mean of 55.5 years (SD10.7). Majority of the patients (90.4%) were above 40 years. The commonest symptom at presentation was dysphonia. A significant proportion of cases (37.3%) presented with locally advanced disease. The commonest histological type of laryngeal tumour seen was squamous cell carcinoma. The treatment offered consisted of radiotherapy for 83 (79.8%) patients and total laryngectomy with neck dissection when necessary for 17 (16.3%) patients who also had postoperative radiotherapy. Only 58 (69.9%) patients completed radiotherapy treatment and in all 32 (24.3 %) patients did not report for any treatment. Majority of patients failed to report for post treatment follow up. We conclude that significant number of patients with laryngeal cancer presented with locally advanced disease and dysphonia was the commonest symptom.

Detection of Basophil Activation by Flow Cytometry in Patients with Allergy to Muscle-relaxant Drugs

ALLERGIC or pseudoallergic reactions that occur during anesthesia have been increasing over the last few years. 1 Muscle-relaxant drugs are responsible for at least half of these life-threatening adverse reactions. 1,2 The diagnosis of drug allergy is mainly based on a detailed clinical history, positive skin tests, and detection of specific immunoglobulin E (IgE). Nevertheless, the biologic results are not always closely correlated with clinical assessment of the disease, and discrepancies between skin tests and specific IgE are reported, 2,3 In these cases, in vitro investigations to identify the responsible drug are needed, and the histamine release (HR) test is usually performed. 2 HR reflects basophil degranulation, but the very small number of circulating basophils is a limitation to this test, and its clinical benefit remains controversial. Because flow cytometry is a valuable tool for identifying cell populations even at low concentrations, we developed a tricolor flow cytometric method (FCM) for the study of allergen-induced basophil activation. 4 Briefly, identification of basophils is based both on CD45 expression (a common leukocyte antigen) and on the presence of IgE on the cell surface, because basophils express high-affinity receptor for IgE. Cell activation on allergen or drug challenge is assessed by the expression of CD63 on the plasma membrane. 5 After the publication of preliminary data (only focused on usual allergens), we initiated studies to evaluate the usefulness of the method in the diagnosis of drug allergy. We report here results of the first four cases of allergy to muscle-relaxant drugs since this FCM was introduced in our laboratory. The patients were recruited from different associated hospitals in Lyon, France, and rapidly developed clinical features evocative of anaphylactic reaction after induction of anesthesia, e.g., hypotension, bronchospasm, and cutaneous signs. Investigations of the responsible drug were performed in the outpatient unit of the Department of Anesthesia (screening for drug allergy unit) at least 2 months after the allergic reaction. Skin prick and intradermal reaction (IDR) tests 3 were performed using various dilutions of drug solutions, specific IgE antibodies (against ammonium group) were measured using radioallergosorbent techniques (Capsystem; Pharmacia, Uppsala, Sweden), histamine was measured using a radioimmunoassay (Immunotech, Marseille, France), and HR test was considered positive when superior to 10% of total HR. Basophil degranulation by FCM was detected by CD63 expression on the cell surface. A positive threshold is defined with a negative control without any drug. Results are positive when > 10% of basophils express CD63.

Can leaflets assist parents in preparing children for hospital?

This article outlines the findings and implications of a small study designed to investigate the perceived usefulness of an information leaflet entitled 'Preparing your child for hospital: a parents' guide'. The study was carried out in an ear, nose and throat unit where children are admitted for elective surgery. A leaflet was developed and field tested before being mailed to a group of parents. An analysis of the data collected demonstrated considerable parental satisfaction with the information contained in the leaflet. The authors believe that similar leaflets should be routinely distributed to families with children awaiting hospital admission.

Audit of the treatment of tonsillar and peritonsillar sepsis in an ear, nose and throat unit.

We became aware that a range of antibiotics were being used in our unit to treat patients suffering from tonsillitis or peritonsillar abscess (quinsy). There appeared to be no rationale to determine which antibiotics were used, and we felt that we were possibly using expensive antibiotics when cheaper equally effective ones were available. An audit project was therefore devised to establish the current practice in the ENT Unit at the City Hospital at Edinburgh. Following a six-month prospective pilot study, a protocol for the treatment of tonsillar and peritonsillar sepsis was drawn up and subsequent practice and outcome was then audited, thus completing the audit cycle. As a result substantial savings in the cost of prescribed antibiotics have been made without compromising patient care.

Alterations in oropharyngeal flora in patients with a nasogastric tube: a cohort study.

To determine whether or not the presence of a nasogastric tube causes a change in the bacterial flora in the oropharynx. Cohort (prospective) design with concurrent control. General Surgical and Ear, Nose, and Throat Units of a tertiary care hospital. Sixteen patients with and 14 patients without a nasogastric tube. Patients scheduled to undergo surgery under general anesthesia with endotracheal intubation were eligible for inclusion in the study. From these patients, a study cohort of 16 consecutive patients who were to have nasogastric tube intubation and 14 patients who were not to have nasogastric intubation were enrolled. All patients had a high oropharyngeal swab taken for bacteriologic culture just before surgery. The swab of the oropharynx for culture was repeated after 48 to 72 hrs. The type of organism grown was identified and compared between and within the two groups. There was a significant increase in the frequency of colonization of the oropharynx by pathogenic Gram-negative bacteria after 48 to 72 hrs of nasogastric intubation in comparison with the preintubation level (p < .01) as well as in comparison with the group that did not have nasogastric intubation (p < .001). The pathogens included Pseudomonas, Klebsiella, Proteus and Escherichia coli. There was also a tendency for suppression of normal flora. There was no significant change in the flora of the control group of patients who did not have nasogastric intubation. The two groups were comparable with respect to age, gender, severity of underlying illness, and use of prophylactic perioperative antibiotics. The presence of nasogastric tubes in patients predisposes to colonization by Gram-negative pathogenic bacteria within 48 to 72 hrs.

Effect of nasogastric tubes on the nose and maxillary sinus

To estimate the proportion of patients who develop radiologic evidence of maxillary sinus inflammation among those who are maintained on nasogastric (NG) tubes after major surgery. Prospective case series. Patients were drawn from the general surgical and ear, nose, and throat units of a tertiary care hospital. All patients undergoing major surgery with or without a concurrent tracheostomy, in whom an NG tube was retained for greater than or equal to 48 hrs, were examined clinically and radiologically for evidence of maxillary sinus inflammation. Sixty-five patients were studied. Twenty patients had a concurrent tracheostomy and 45 patients were without tracheostomy. Only 10% of the patients in the tracheostomy group developed radiologic evidence of sinus inflammation, as compared with 50% in the nontracheostomy group (p less than .05). The proportion of patients who developed clinical evidence of rhinitis was about 75% in either group. However, none of the patients in the study had clinical evidence of maxillary sinusitis. There was no correlation between the age of the patient, sex, use of broad-spectrum antibiotics, or duration of NG intubation with the onset of sinus inflammation. The presence of NG tubes predisposes to nasal and maxillary sinus inflammation. Sinonasal symptoms of clinical sinusitis may not be present even when radiologic evidence of inflammation is evident. In patients with tracheostomy, the frequency of maxillary sinus inflammation is significantly lower than in those patients without tracheostomy.