Sjogren's syndrome: Clinical aspects.

Sjogren's syndrome (SS) is the 2nd most common chronic autoimmune rheumatic disease and associated with a high burden of illness. Morbidity arises not only from untreated xerostomia and keratoconjunctivitis sicca but also from extra-glandular manifestations including the development of non-Hodgkin's B cell lymphomas. Proper diagnosis of SS requires objective evidence of dry eyes and/or objective evidence of dry mouth as well as proof of autoimmunity. The recent development of new international classification criteria and clinical practice guidelines for SS should not only enhance the existing standards of care but also facilitate further studies to improve future diagnosis and outcomes.

Current demand of paediatric otolaryngology input for children with Down's syndrome in a tertiary referral centre.

OBJECTIVE: This study aimed to evaluate the activity of paediatric otolaryngology services required for children with Down's syndrome in a tertiary referral centre. METHODS: A review of the paediatric otolaryngology input for children with Down's syndrome was performed; data were obtained from the coding department for a two-year period and compared with other surgical specialties. RESULTS: Between June 2011 and May 2013, 106 otolaryngology procedures were performed on children with Down's syndrome. This compared to 87 cardiac and 81 general paediatrics cases. The most common pathologies in children with Down's syndrome were obstructive sleep apnoea, otitis media, hearing loss and cardiac disease. The most common otolaryngology procedures performed were adenoidectomy, tonsillectomy, grommet insertion and bone-anchored hearing aid implant surgery. CONCLUSION: ENT manifestations of Down's syndrome are common. Greater provisions need to be made to streamline the otolaryngology services for children and improve transition of care to adult services.

Structured clinical assessment of the ear, nose and throat in patients with granulomatosis with polyangiitis (Wegener's).

The objective of this prospective cross-sectional study is to describe the clinical otorhinolaryngological manifestations of granulomatosis with polyangiitis (Wegener's) (GPA) in a prospective cohort. All patients suffering from GPA seen in a tertiary centre between March 2007 and November 2008 had a detailed clinical assessment by an ENT surgeon of their ear, nose and head and neck complaints. An evaluation of whether there was disease activity and/or infection in each ENT area was made using the European Vasculitis Study Group guidelines. The number of patients assessed was 144. The proportion of female patients was 47 % (n = 69) and the median age was 57.7 years (IQ range 42.5-68.5). The prevalence of ENT involvement was 87 % (125/144). Hearing loss and abnormal tympanic membrane appearance were more common in patients with active disease and no infection (7/8 and 6/8, respectively, in active disease cf. 59/131 and 52/131, respectively, in remission). Nasal crusting was the most common nasal complaint recorded (52/144, 36 %) and bloody rhinorrhoea was the most common symptom in patients with disease activity. Rhinoscopy was highly sensitive in diagnosing disease activity (100 %). Subglottic stenosis was the most common head and neck manifestation (27/121, 22 %) and 74 % were symptomatic. In conclusion, the pattern and frequency of clinical ENT manifestations in GPA have been described in a large patient cohort. The use of tools readily available in the ENT clinic was essential to assess these patients accurately. This dataset will form the basis of an objective scoring system to measure disease activity in the ENT system.

[Epidemiology and prophylaxis of ENT diseases in the cadets of the Nakhimov Naval School].

The objective of the present study was to determine the prevalence of otorhinolaryngological morbidity among the cadets of the Nakhimov Naval School and propose the effective measures for its reduction and prevention. A total of 335 children at the age from 11 to 17 years were available for the examination. The analysis of otorhinolaryngological morbidity during September and October 2011 revealed the high frequency of acute respiratory diseases (46 cases) and maxillary sinus symptoms (12 cases). The newly recruited children accounted for 40% of the affected patients. The results of the screening carried out in the military educational institution suggest the necessity of improvement of the quality of primary medical screening, timely diagnostics and correction of pathological conditions. They can be used to formulate the long-range objectives for the improvement of individual recommendations for the medical observation of the cadets presenting with chronic ENT diseases.

Adding allergy to your practice.

The ability to blend the management of allergic disease into the general treatment of head and neck disease is core to the otolaryngologist's role as regional specialist of the upper aerodigestive tract. Allergy training is now considered an integral component of the residency curriculum established by the American Board of Otolaryngology. By obtaining any needed additional training through organizations such as the AAOA and by validating that education by obtaining fellowship status in the AAOA, the postgraduate otolaryngologist who adds allergy to his or her practice will find the techniques to be safe, effective, and of great benefits to patients.

[ENT expert assessment for federal health insurance in North Rhine. A contribution to the internal discussion of quantitative and qualitative optimization of the expert witness process]. / HNO-Begutachtung im MDK Nordrhein. Ein Beitrag zur internen Diskussion über die quantitative und qualitative Optimierung eines Begutachtungsprozesses.

Contribution to an Internal Discussion on Quantitative and Qualitative Optimisation of Expertising Procedures: The medical advisory and expertising Services of the German statutory sickness insurance are according to German social legislation authorised to request supporting documents direct from the treating physicians or hospitals. The consultant medical expertiser for ENT diseases at Cologne worked out the percentage of requests that resulted in "further investigations" and the amount of work involved. A document form was used to record all such requests for a given period. 154 expertising procedures concerning ENT diseases were counted within a period of 5 weeks. 47% of the patients concerned pertained to workers' sickness insurance funds and 29% to guilds sickness insurance funds. Two thirds of all requests were channelled through the statutory sociomedical preconsultant service and one-third were sent by post. 55% of all the requested documents were considered to be "complete" and 45% "incomplete". N = 100 requests were initial and N = 54 were follow-up requests. The answers received were considered satisfactory and final in 62% of the requests, whereas "further inquiries" were considered necessary in n = 58 (38%) of the cases. 80% of the cases in which the requests resulted in satisfactory information, were approved for sickness insurance payment and approximately 20% were rejected. The average period of time that elapsed between a request for more information and the reply and the final expertising given to and passed on to the patient by the statutory insurance body was 2 weeks. In cases where "further inquiries" are considered necessary, three additional working days are usually required in the Cologne ENT diseases area. If the statutory sociomedical preconsultant service procedure could be intensified, this would result in better channelling of requests by the ENT medical and advisory service of the stautory sickness insurance bodies. A more pronounced examination by the statutory sociomedical preconsultant service could minimise the need for additional requests, follow-ups and "further inquiries" and could increase the speed of completion of approved or rejected insurance cases from 14 days to at the most one day or even 0 days. This pilot study was conducted to encourage the local bodies to optimise their work. In the long run good quality of work, patient satifaction and patients' job security will result and will be the corner-stones of modern quality assurance and quality management in North-Rhine Westphalian medical expertising and consultant services in association with the relevant statutory sickness insurance bodies.

[Emergencies in otorhinolaryngology: etiologic study]. / Urgencias en otorrinolaringología: estudio etiológico.

The paper deals on an epidemiologic survey of 5,649 patients calling for facilities at the Emergency area of the E.N.T.-Department of the University Hospital, of Barcelona. The cases were codified to avoid overlapping as follows: Age, Sex, Day of the week and Month of the year, urging for medical care, etiology and seriousness of the illness, and at last, the degree of adequacy of the Emergency ward for the service required. With all the collected data the AA, guess about the adequacy in each case for the patient's admission at the Emergency Unit.

[Constant rate enteral feeding in the patient's home. Clinical experience in paediatrics (111 children) (author's transl)]. / Nutrition entérale à débit constant à domicile. Expérience chez 111 enfants.

Constant rate enteral feeding in the patient's home considerably shortens the stay of children in a specialized pediatric unit. A study of 111 children treated by this method for the past 5 years shows that, provided close co-operation with the family is obtained, obvious psychological benefits can be expected with little risk of technical complications. From an economic point of view, the method provides an effective means of reducing costs.