Peculiarities of situational and personal anxiety degree in the schoolchildren with ENT chronic diseases.

BACKGROUND: A number of the QL researches in case of different pathologies are being increased during the last decade. The existing traditional research methods provide mostly arbitrary data on the disease and its treatment, which are not sufficient for the schoolchildren overall psychological and social adaptation and wellness evaluation. METHODS: The research object became schoolchildren of 3 randomly selected schools in Yerevan. 443 monitoring units formed the selection population. The degree of situational and personal anxiety was evaluated with the help of Spielberger's and Gerbachevski's tests. RESULTS: According to our research data the anxiety degree was 29,2 ± 2,3 points among the girls and 12,5 ± 1,6 points among the boys, respectively. The individual anxiety level was especially high: it made up 44,5 ± 0,8 points, and that of the situational anxiety made up 37,2 ± 0,5 points (p < 0,05). According to Gerbachovski's test in the group of schoolchildren with ENT pathology those with a high level of demands made up 53,5 ± 3,2%, with a medium level of demands - 32,4 ± 3,0% and with a low level of demands -14,1 ± 2,2%. A number of the practically healthy schoolchildren with a low level of demands made up 50,3%, and with a high level - 30,7%. CONCLUSION: According to the investigation data those children who suffer from the ENT chronic diseases usually avoided communication, were sluggish and shy. According to the results of the research, the socio-psychological and adaptation abilities of children with the ENT chronic diseases were lower than those of the practically healthy (without ENT pathologies) coevals. This fact urges to improve the prophylactic measures provision in the mentioned pathologies aspect.

The potential of eHealth in otorhinolaryngology-head and neck surgery: patients' perspectives.

The use of modern information and communication technologies (ICT) in daily life has significantly increased during the last several years. These essential online technologies have also found their way into the healthcare system. The use of modern ICT for health reasons can be summarized by the term 'eHealth'. Despite the potential importance of eHealth in the field of otorhinolaryngology (ORL), there is little understanding of patients' attitudes towards the deeper integration of these technologies into intersectoral care. The aim of this study was to gain a better understanding of patients' attitudes towards the use of modern ICT for intersectoral communication and information transfer in the field of ORL. Therefore, a structured interview was developed by an interdisciplinary team of otorhinolaryngologists, public health researchers, and information technology (IT) specialists. Overall, 211 ORL patients were interviewed at the Department of Otorhinolaryngology-Head and Neck Surgery, Tuebingen University Hospital, Germany, and 203 of these patients completed the interview. This study revealed ORL patients' perspectives on the potential of eHealth, especially for appointment scheduling, appointment reminders, and intersectoral communication of personal medical information. Furthermore, this study provides evidence that data security and the impacts of eHealth on the physician-patient relationship and on treatment quality warrant special attention in future research.

The Cambridge Otology Quality of Life Questionnaire: an otology-specific patient-recorded outcome measure. A paper describing the instrument design and a report of preliminary reliability and validity.

OBJECTIVE: The Cambridge Otology Quality of Life Questionnaire (COQOL) is a patient-recorded outcome measurement (PROM) designed to quantify the quality of life of patients attending otology clinics. DESIGN: Item-reduction model. A systematically designed long-form version (74 items) was tested with patient focus groups before being presented to adult otology patients (n. 137). Preliminary item analysis tested reliability, reducing the COQOL to 24 questions. This was then presented in conjunction with the SF-36 (V1) questionnaire to a total of 203 patients. Subsequently, these were re-presented at T + 3 months, and patients recorded whether they felt their condition had improved, deteriorated or remained the same. Non-responders were contacted by post. A correlation between COQOL scores and patient perception of change was examined to analyse content validity. SETTING: Teaching hospital and university psychology department. PARTICIPANTS: Adult patients attending otology clinics with a wide range of otological conditions. MAIN OUTCOME MEASUREMENTS: Item reliability measured by item­total correlation, internal consistency and test­ retest reliability. Validity measured by correlation between COQOL scores and patient-reported symptom change. RESULTS: Reliability: the COQOL showed excellent internal consistency at both initial presentation (a = 0.90) and 3 months later (a = 0.93). Validity: One-way analysis of variance showed a significant difference between groups reporting change and those reporting no change in quality of life (F(2, 80) = 5.866, P < 0.01). CONCLUSIONS: The COQOL is the first otology-specific PROM. Initial studies demonstrate excellent reliability and encouraging preliminary criterion validity: further studies will allow a deeper validation of the instrument.

Peculiarities of clinical profile of snoring and mild to moderate obstructive sleep apnea-hypopnea syndrome patients.

PURPOSE: The purpose of this study is to perform comprehensive evaluation of the snoring and mild to moderate obstructive sleep apnea-hypopnea syndrome (OSAHS) patients for their anatomical, functional, and psychoemotional clinical properties. METHODS: Seventy-four snoring patients, aged 24 to 64 (mean 41.83 ± 11.01) years underwent full-night polysomnography, nasopharyngoscopy, and Mueller maneuver. Clinical tests battery consisting of visual analogue scales (VAS) scales, Lithuanian version of Sleep Apnea Quality of Life Index (SAQLI-LT), Spielberg's State-Trait Anxiety Inventory (STAI), Beck Depression Inventory-Second Edition (BDI-II), and Epworth Sleepiness Scale (ESS) were applied to assess their distinctive clinical properties. RESULTS: The total group of snoring and mild to moderate OSAHS patients presented with considerably enlarged VAS snoring and daytime sleepiness scores (mean 66.32 ± 19.07 and 35.03 ± 27.83 points), mild BDI-II scores (mean 10.96 ± 9.42 points), and moderate trait anxiety scores (mean 41.51 ± 8.62 points). All the scores of daytime complaints measured with the VAS correlated statistically significantly with the mean scores of the ESS, SAQLI-LT, trait anxiety, and BDI-II. Both groups, of snoring and mild to moderate OSAHS patients, indicated similar intensity of the major complaints according to the VAS, same as similar BDI-II, STAI, and SAQLI-LT scores. A higher Friedman's score of palatal tonsils was found in the group of snoring patients, comparing to that of the group of mild to moderate OSAHS patients (p < 0.05). CONCLUSIONS: Snoring and mild to moderate OSAHS patients have resemblances in their distinctive anatomical and clinical properties. This group of the patients revealed mild depression and moderate trait anxiety scores when measured with the BDI-II and STAI, which correlated significantly with the severity of the patients' daytime complaints measured with the VAS.

Functional consequences of chronic ENT inflammation on the development of hearing and communicative abilities.

Hearing processing and communication abilities development may be influenced by chronic inflammation of the airways in children, especially in case of otitis media and/or adenotonsillar hypertrophy. The present review summarizes the influence of adenotonsillar hypertrophy on speech abilities as well as the consequences of otitis media, with a particular focus on peripheral and central hearing, on the development of language, attention, and memory skills.

Development of an item bank for the assessment of depression in persons with mental illnesses and physical diseases using Rasch analysis.

OBJECTIVE: The calibration of item banks provides the basis for computerized adaptive testing that ensures high diagnostic precision and minimizes participants' test burden. The present study aimed at developing a new item bank that allows for assessing depression in persons with mental and persons with somatic diseases. METHOD: The sample consisted of 161 participants treated for a depressive syndrome, and 206 participants with somatic illnesses (103 cardiologic, 103 otorhinolaryngologic; overall mean age = 44.1 years, SD =14.0; 44.7% women) to allow for validation of the item bank in both groups. Persons answered a pool of 182 depression items on a 5-point Likert scale. RESULTS: Evaluation of Rasch model fit (infit < 1.3), differential item functioning, dimensionality, local independence, item spread, item and person separation (>2.0), and reliability (>.80) resulted in a bank of 79 items with good psychometric properties. CONCLUSIONS: The bank provides items with a wide range of content coverage and may serve as a sound basis for computerized adaptive testing applications. It might also be useful for researchers who wish to develop new fixed-length scales for the assessment of depression in specific rehabilitation settings.

[Psychosomatic treatment of otorhinolaryngological diseases]. / Psychosomatische Behandlungen bei HNO-Erkrankungen.

The spectrum of psychosomatic diseases in the field of otorhinolaryngology covers reactive disorders brought on by excessive psychosocial demands, post-traumatic disorders following mental traumatization, purely psychological disorders brought on by personality development deficits or learnt false behavior, and multifactorial diseases with somatic correlatives and mental triggers. Psychosomatic medicine describes the interaction of physical and psychological processes. The central treatment method is psychotherapy. In Germany, the costs of psychodynamic psychotherapies and behavioral therapy are covered by the health insurance companies. The tasks of psychosomatic treatment in the field of otorhinolaryngology comprise differential diagnostics, basic psychosomatic treatment and the determination of differential indications for the respective forms of psychotherapy.

[The quality of life in patients with ENT pathology].

The main results of a medico-sociological study are reported with special reference to the assessment of medico-social status and quality of life in patients with ENT pathology who were treated in a commercial medical centre. The study demonstrated that ENT diseases have negative effect on the working capacity, sleep, and the ability to perform physical exercises. In more than half of the respondents, pathological changes in ENT organs turned out to be a cause of deterioration of family relationships and the resulting impairment of the quality of life.

Prevalence of depression and anxiety among otolaryngology outpatients at Jordan University Hospital.

PURPOSE: To determine the prevalence of depression and anxiety among otolaryngology outpatients at Jordan University Hospital. METHODS: A cross-sectional observational study was conducted between January 2017 and February 2018. The sample included 1328 otolaryngology adult outpatients, who completed (PHQ-9) and (GAD-7) questionnaires for depression and anxiety. Sociodemographic and clinical data were recorded. RESULTS: Depression and anxiety prevalence rates were 36.1% and 22.9%. The significant risk factors found for them were: age range 30 to 50 years, female sex, divorced status, smoking, alcohol drinking, asthma, family history of psychiatric illness, chronic illnesses, negative life events, secondary education, unemployment, low income, globus pharyngeus, tinnitus, and dizziness. PRACTICE IMPLICATIONS: Healthcare providers should have the vigilance to suspect and treat these disorders to improve patients' symptoms and quality of life.

Introduction to genetics for otorhinolaryngology nurses.

Advances in human genetics have led to considerable changes in the way health professionals, especially nurses, understand and care for their patients. This article is focused on the clinical implications of genetic aspects of conditions of the head and neck, written for otorhinolaryngology (ORL) and head-neck nurses, but relevant for other nurses as well. This article presents information about basic inheritance patterns (autosomal dominant and recessive, X-linked, and mitochondrial) and compares single-gene disorders to complex or mutifactorial diseases. Cleft lip and palate disorders (Robin sequence and Van der Woude syndrome) and other craniofacial conditions (craniosynostosis, Treacher-Collins syndrome, and velo-cardio-facial syndrome) are discussed along with non-syndromic and syndromic hearing loss. Discussion of the psychosocial aspects of genetic conditions of the head and neck and a glossary of genetic terms are included.

Unfounded worries about cancer in patients attending a routine otolaryngology clinic.

To investigate a suspicion that many ear, nose and throat patients have unfounded concerns about cancer, we questioned 50 patients who had attended a routine clinic after screening-out of those with possibly cancer-related features. None of the 50 proved to have cancer. 15 (30%) had been worried about cancer and 7 of these were still worried despite the consultation. Unwarranted fears about cancer are best dealt with by the referring clinician, especially when the wait for an appointment will be long. Such fears also need to be recognized and addressed by the specialist.

Psychiatric consultation on an otolaryngology liaison service.

Otolaryngology patients (especially those with tracheostomies) present a significant challenge to psychiatrists from both a diagnostic and therapeutic standpoint. To date, no study has been made of psychiatric disorders among this important group of patients. At the Mount Sinai Medical Center, a liaison psychiatrist has been involved with a specialized otolaryngology cluster unit since 1979. Using a 384-item computerized database protocol developed at Mount Sinai, data on 139 otolaryngology patients were recorded and compared with 1662 "Other" inpatient psychiatric consultations on the medical and surgical services during 1980-1987. The otolaryngology patients as a group were more likely to be male (p = 0.011), married (p = 0.001) and employed (p less than 0.001). Cancer was the most common medical disorder, and the average level of stress as reported on DSM-III's Axis IV (5.1, severe) was significantly greater (p less than 0.0001) than that for the "Other." The most common psychiatric response was adjustment disorder (36%). The length of stay of those ENT patients seen in psychiatric consultation was 26.4 days, in contrast to 11.1 days for all ENT patients. However, the length of stay of those patients on ENT receiving a psychiatric consultation was not different from the "Other" psychiatric consultation cohort (26.3 days). Despite the higher level of stress, the incidence of significant psychiatric morbidity was lower for the ENT cohort. The primary effect of the liaison psychiatrist was to lower the threshold for case identification that enhanced the referral rate on the ENT unit.

Psychotherapy of the otolaryngology patient.

Psychotherapy is an essential skill in the treatment of the medically ill patient. It represents to a significant extent the manner in which we understand and intervene in the patient's efforts to cope with overwhelming loss and grief. Psychotherapy of the Otolaryngology patient is especially challenging because of the substantial impediments to communication in this population. This paper will review some of the special issues that apply to many medically or surgically ill individuals but which are almost universal to the Otolaryngology patients. In particular the special topics of "Body Image" including disfigurement and cosmetic surgery, and "The Role of Verbalization" will be discussed. Consideration is also given to the special topic of countertransference which is also encountered in psychotherapy in reaction to these patients.

Psychiatric aspects of head and neck surgery. Part II: Body image and psychiatric intervention.

Surgery of the head and neck leads to profound changes of body image, including disfigurement and difficulties with verbalization. The psychologic importance of alterations in these areas will be discussed as well as their effect on the conduct of psychiatric treatment. Psychiatric intervention in this population demands an active approach and special preparation for the therapeutic encounter is necessary.

Otolaryngologica prevarica: Munchausen's syndrome update and report of a case.

Colorful lying is a central feature of Munchausen's, a syndrome well characterized despite an imperfect understanding of its psychiatric aspects. Reported otolaryngologic presentations are infrequent. A classic case is described in detail. A new name, "Otolaryngologica Prevarica," is proposed to maintain awareness of the entity in the specialty. The psychodynamics and the relation to sadomasochism, hysteria and malingering are discussed.

Liaison psychiatry-otolaryngology rounds.

In an attempt to define and resolve patient and staff needs with regard to the psychological, social and economic problems in clinical otolaryngology, psychiatry/otolaryngology rounds were established in the Department of Otolaryngology 18 months ago. These weekly rounds have contributed greatly to improved patient care and better physician-nurse relations. They have also served a significant educational role for residents, medical students and other members of the patient care team. At present the rounds are attended by the inpatient nursing staff, 2 physicians, 6 residents, 3 medical students, an otolaryngologic social worker and the liaison psychiatrist. The meeting begins with a 10 minute discussion and review of current problems among the staff. Attention is then directed to the patient who will be interviewed for the day. The medical and social history are presented. Then the patient is brought in and interviewed in a non-stressful session for 20 minutes. After the patient leaves, the staff discusses the problems which the patient has encountered or poses to them, and the conference participants formulate an appropriate therapeutic plan. Among the problems which have been discussed are noncompliance, organic mental syndromes, hypochondirasis, depression, death and dying, disfigurement, loss of bodily function, and chronic pain. For those patients in whom further psychiatric evaluation and treatment are deemed necessary, the psychiatrist becomes an active participant in their clinical care.

Measuring patient benefit from otorhinolaryngological surgery and therapy.

The Glasgow Benefit Inventory (GBI) is a measure of patient benefit developed especially for otorhinolaryngological (ORL) interventions. Patient benefit is the change in health status resulting from health care intervention. The GBI was developed to be patient-oriented, to be maximally sensitive to ORL interventions, and to provide a common metric to compare benefit across different interventions. The GBI is an 18-item, postintervention questionnaire intended to be given to patients to fill in at home or in the outpatient clinic. In the first part of the paper, five different ORL interventions were retrospectively studied: middle ear surgery to improve hearing, provision of a cochlear implant, middle ear surgery to eradicate ear activity, rhinoplasty, and tonsillectomy. A criterion that was specific to the intervention was selected for each study, so that the patient outcome could be classified as above and below criterion. In all five interventions, the GBI was found to discriminate between above- and below-criterion outcomes. The second part of the paper reports on the results and implications of a factor analysis of patient responses. The factor structure was robust across the study, and so led to the construction of subscales. These subscales yield a profile score that provides information on the different types of patient benefit resulting from ORL interventions. The GBI is sensitive to the different ORL interventions, yet is sufficiently general to enable comparison between each pair of interventions. It provides a profile score, which enables further breakdown of results. As it provides a patient-oriented common metric, it is anticipated that the GBI will assist audit, research, and health policy planning.

The role of the psychiatrist in otolaryngology.

The patient, staff, and physician benefit when the otolaryngologist and psychiatrist are able to work closely together. Not only is clinical care improved, but time can be spent more efficiently in dealing directly with the patient's problem.

Do otolaryngology out-patients use the internet prior to attending their appointment?

The Internet has become a very important source of health information. We wanted to determine otolaryngology patients' access to, and use of, the Internet as a medical information resource, to identify factors that make patients more likely to use it, and to determine how useful they find this information. A questionnaire survey was completed by patients while waiting for their consultation in the out-patient department of the Royal National Throat Nose and Ear Hospital in London. Five hundred and thirty-five questionnaires were completed. Sixty-four per cent (344/535) reported having access to the Web. Of the 344 with access, 62 (18 per cent) had searched the Web for medical information prior to their consultation. Higher education (p <0.001) and age between 18 and 40 years (p = 0.001) correlated significantly with higher Internet use. Ninety-five per cent planned to use the Internet again. Approximately one out of five otolaryngology out-patients with Internet access reported having obtained medical information from the Web before their consultation. The majority found it helpful to some degree and were planning to use it again. As clinicians we should be aware of this use and the onus should be on ourselves to review these sites in order to guide our patients to sources of reliable and helpful medical information on the Internet.

Waiting-list prioritization in the National Health Service.

The aim of this study was to find out whether there is a consensus of opinion among healthcare providers and different sections of the public on the relative prioritization of common otolaryngological conditions for outpatient consultations and inpatient treatment. ENT consultants, general practitioners, administrators, NHS employees, non-ENT patients and members of the general public were given common scenarios of otolaryngological conditions and asked to prioritize them in order of importance. All the groups gave top priority for patients with suspected cancer of the larynx (outpatients) and for surgical treatment of cancer. Children with hearing problems were more commonly ranked in the top three categories than children requiring treatment for sore throats. All groups assigned those requiring rhinoplasty, treatment for snoring or hearing aids to the last three ranks. This study shows that there is a remarkable uniformity of opinion in determining clinical priorities which is similar to the traditional policies practised by UK ENT consultants.