RESUMEN
INTRODUCTION: Antiplatelet agents such as aspirin and clopidogrel are increasingly encountered in clinical practice. Otorhinolaryngological surgeons are involved in the peri-operative decision of whether to continue treatment and risk haemorrhage or to discontinue treatment and risk thrombosis. METHODS: Literature relating to the risk of spontaneous or operative haemorrhage was reviewed. The morbidity and mortality associated with cessation of agents was evaluated. Published guidelines were also evaluated. A protocol for the management of antiplatelet agents in the peri-operative period, with particular reference to ENT operations, is presented. CONCLUSION: SIGNIFICANT morbidity and mortality is associated with the premature cessation of antiplatelet agents. Data from cardiac surgery suggest that operative blood loss only marginally increases in patients on aspirin and clopidogrel. However, the management of antiplatelet agents in the peri-operative period should be made after multidisciplinary consultation.
Asunto(s)
Aspirina/administración & dosificación , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Procedimientos Quirúrgicos Otorrinolaringológicos , Atención Perioperativa/métodos , Inhibidores de Agregación Plaquetaria/administración & dosificación , Ticlopidina/análogos & derivados , Aspirina/efectos adversos , Aspirina/farmacología , Pérdida de Sangre Quirúrgica/prevención & control , Clopidogrel , Toma de Decisiones , Stents Liberadores de Fármacos , Humanos , Inhibidores de Agregación Plaquetaria/efectos adversos , Inhibidores de Agregación Plaquetaria/farmacología , Factores de Riesgo , Trombosis/prevención & control , Ticlopidina/administración & dosificación , Ticlopidina/efectos adversos , Ticlopidina/farmacologíaRESUMEN
OBJECTIVE: This study aimed to evaluate voice and quality of life after transoral laser resection of early glottic carcinoma. METHODS: We studied 19 patients undergoing transoral laser resection of tumour stage (T) one or T2 glottic carcinoma. Laryngeal function was evaluated by video-stroboscopy, vocal function by the Voice Symptom Scale, the grade-roughness-breathiness-asthenia-strain scale and objective phoniatric assessment, and quality of life by the University of Washington Quality of Life questionnaire. RESULTS: Patients' glottic carcinoma tumour-node-metastasis (TNM) staging was T1 N0 M0 in 14 patients and T2 N0 M0 in five. Overall voice grade, roughness and breathiness were mild to moderate in 84 per cent; asthenia and voice strain were more uniformly distributed, with 15 per cent of patients having normal voice quality. Eight patients developed a glottic web post-operatively; anterior commissure web was significantly associated with worse voice grade (p = 0.05). Seven patients (47 per cent) had a 'mucosal wave' on the operated vocal fold; this was significantly associated with less strain on phonation (p = 0.05). Voice Symptom Scale score was low overall (15 patients (78.9 per cent) scored less than 30). The fundamental frequency and frequency irregularity were normal in nine patients (47.3 per cent); the closed quotient was normal in six (31.5 per cent). The averaged quality of life score was ≥ 90 in 14 patients (73.7 per cent); 18 (94.7 per cent) felt their health-related quality of life was either the same or better post-operatively; and overall quality of life was positive in all. CONCLUSION: Transoral laser resection of T1 and T2 glottic carcinoma enables adequate tumour tissue excision with preservation of acceptable vocal function. Most patients' post-operative quality of life is very good. Anterior commissure web formation is associated with poorer vocal function.
Asunto(s)
Carcinoma/cirugía , Glotis/cirugía , Neoplasias Laríngeas/cirugía , Calidad de Vida , Encuestas y Cuestionarios , Trastornos de la Voz/diagnóstico , Anciano , Anciano de 80 o más Años , Carcinoma/patología , Carcinoma/fisiopatología , Estudios Transversales , Humanos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/fisiopatología , Laringoscopía , Terapia por Láser/métodos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Evaluación de Resultado en la Atención de Salud/métodos , Índice de Severidad de la Enfermedad , Estroboscopía , Trastornos de la Voz/fisiopatología , Trastornos de la Voz/psicología , Calidad de la Voz/fisiologíaRESUMEN
The surgical management for otosclerosis has evolved from stapes mobilisation to total extraction of the footplate, the so called 'stapedectomy', to a small hole in the stapes footplate, the 'stapedotomy'. The aim of stapes surgery is to restore the vibration of fluids within the cochlear canal. Revision stapedectomy should be approached with caution. Stapedectomy can lead to some minor and other more serious complications.
Asunto(s)
Otosclerosis/cirugía , Cirugía del Estribo/métodos , Implantación Coclear/métodos , Humanos , Complicaciones Posoperatorias/etiología , Reoperación , Insuficiencia del TratamientoRESUMEN
The rationale for medical therapy for otospongiosis is to slow down and eventually stop the phase of bone resorption. There is some increase in the incidence of stapedial otospongiosis in a low-fluoride area compared with a high-fluoride area. Sodium fluoride treatment has a role to play in preventing the onset and progression of hearing loss in patients suffering from otosclerosis. Sodium fluoride therapy has been shown to have some beneficial effect on dizziness associated with otosclerosis. In view of the possibility of systemic side effects of sodium fluoride therapy, a regular follow up of patients is warranted. Biphosphonates can be used as an alternative treatment to sodium fluoride in cases where the patient is intolerant to sodium fluoride therapy. Hearing aid is also a treatment option, but it does not halt the disease process.
Asunto(s)
Difosfonatos/uso terapéutico , Otosclerosis/tratamiento farmacológico , Ensayos Clínicos como Asunto , Humanos , Fluoruro de Sodio/uso terapéutico , Acúfeno/tratamiento farmacológico , Acúfeno/etiología , Resultado del Tratamiento , Vértigo/tratamiento farmacológico , Vértigo/etiologíaRESUMEN
Otosclerosis is a bone dystrophy localised to the inner ear and the stapes footplate. Otosclerosis is a frequent cause of deafness in adults. The patient with otosclerosis typically presents with a history of slowly progressive conductive or mixed hearing loss that is usually bilateral and often asymmetric, usually between the ages of 15 and 45 years. The disease is characterised by alternating phases of bone resorption and formation. The majority of studies on families with otosclerosis suggest an autosomal dominant mode of inheritance with incomplete penetrance.
Asunto(s)
Otosclerosis/etiología , Audiometría/métodos , Pérdida Auditiva Sensorineural/diagnóstico , Pérdida Auditiva Sensorineural/etiología , Humanos , Otosclerosis/diagnóstico , Examen Físico/métodosRESUMEN
OBJECTIVE: Although modern endoscopic laser techniques aim to avoid a permanent tracheostomy by augmenting the glottic aperture in cases of bilateral vocal fold palsy, loss of tissue from the posterior glottis risks compromising voice quality and swallowing function. The objective of this study was to describe our experience with bilateral transverse posterior cordotomy. METHODS: This was a retrospective analysis of functional outcomes in a series of consecutive patients undergoing a simple modification of the classical laser cordectomy procedure, which avoids tissue loss. The procedure was confined to the complete release of the vocal ligament from the arytenoid cartilage on both sides, while avoiding any significant loss of mucosa or cartilage. RESULTS: Post-operative voice quality and quality of life were rated as good by most patients, which makes bilateral transverse cordotomy an attractive treatment option for bilateral vocal fold paralysis. CONCLUSION: Bilateral transverse cordotomy is a reliable treatment option for patients with bilateral vocal fold paralysis, and aims to avoid the morbidity associated with a permanent tracheostomy.
Asunto(s)
Deglución/fisiología , Parálisis de los Pliegues Vocales/cirugía , Pliegues Vocales/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Láseres de Gas/uso terapéutico , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Calidad de Vida , Estudios Retrospectivos , Traqueostomía/efectos adversos , Resultado del Tratamiento , Parálisis de los Pliegues Vocales/fisiopatología , Pliegues Vocales/fisiología , Calidad de la Voz/fisiologíaRESUMEN
Many patients who present with otalgia have a normal otological examination, and a distant source of pain must be considered. The ear receives an extensive sensory innervation arising from six nerve roots. Many other structures in the head, neck and thorax share a common neuronal pathway with the ear, and these tissues represent the possible sites of disease in the cases of referred otalgia. Consequently, the differential diagnosis is extensive and varied. Making an accurate diagnosis relies on an understanding of the complex distribution of nerve fibres and a structured approach to patient assessment. This article aims to classify the aetiology of referred otalgia and to outline current treatments for these conditions. The origins of referred otalgia may be as remote as the cranial cavity and thorax; however, dental disease, tonsillitis, temporomandibular joint disorders and cervical spine pathology represent the most frequent causes. Ear pain may also be the first sign of a head and neck malignancy. Patients complaining of otalgia, with risk factors for an aerodigestive neoplasm, and a normal ENT examination require an urgent otolaryngological opinion.
Asunto(s)
Dolor de Oído/etiología , Oído/inervación , Dolor de Oído/diagnóstico , Dolor de Oído/terapia , Humanos , Factores de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
Cowden disease is a genetically inherited disorder presenting with multiple hamartomatous and neoplastic lesions in various organs and tissues. We present a review of the diagnostic criteria, clinical presentation, genetics, and management of this condition.
Asunto(s)
Síndrome de Hamartoma Múltiple/diagnóstico , Adolescente , Adulto , Anciano , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/genética , Neoplasias Gastrointestinales/diagnóstico , Neoplasias Gastrointestinales/genética , Síndrome de Hamartoma Múltiple/genética , Síndrome de Hamartoma Múltiple/terapia , Humanos , Persona de Mediana Edad , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/genéticaRESUMEN
We describe a series of four patients who presented with 'high globus pharyngeus', who all had an abnormally curled epiglottis tip touching and indenting the tongue base. The actual incidence of 'curling epiglottis', as well as the potential impact of this variation in persistent globus symptoms, is not known. We therefore describe for the first time a series of patients with this anatomical variant of the epiglottis, each of whom experienced unresolved globus symptoms despite receiving intensive medical treatment. In the literature, the success rate for improvement in symptoms following medical treatment ranges from 68 to 80 per cent. Following CO2 laser partial epiglottectomy, all four patients experienced complete relief of their symptoms. We advocate consideration of this treatment for high globus pharyngeus that fails to respond to conservative treatment, in cases with proven curled epiglottis on endoscopic examination.
Asunto(s)
Epiglotis/anomalías , Adulto , Anciano , Diagnóstico Diferencial , Epiglotis/cirugía , Femenino , Humanos , Laringoscopía , Persona de Mediana Edad , Embarazo , Resultado del TratamientoRESUMEN
Following a previous paper in which we documented the otological side effects of drug therapy, we here review other drug side effects that ENT surgeons may encounter when dealing with patients. Although otological drug side effects such as hearing loss and tinnitus are well recognized there are many rhinological, laryngeal, oropharyngeal and other head and neck drug side effects. Our data were sourced from the British National Formulary and Electronic Medical Compendium websites.
Asunto(s)
Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Bases de Datos Factuales , Formularios Farmacéuticos como Asunto , Humanos , Internet , Enfermedades de la Laringe/inducido químicamente , Enfermedades Nasales/inducido químicamente , Enfermedades Faríngeas/inducido químicamenteRESUMEN
Neurological complications of acute mastoiditis are rare but can be life threatening. Their presentation may be masked by the use of antibiotics. We present a unique case of acute otitis media progressing to occipital, extradural and subdural abscess formation and lateral sinus thrombosis in a child. The clinical course and management of a pre-adolescent male is presented and discussed. We review the incidence, presentation and treatment of occipital abscesses and lateral sinus thrombosis with acute mastoiditis. Following extended cortical mastoidectomy, neck exploration and broad spectrum intravenous antibiotics, the patient made a full recovery. This is the first reported case of acute mastoiditis associated with occipital abscess in a child. Early, aggressive treatment is required for a successful outcome. The rarity of neurological complications, in addition to the insidious onset and subtle symptoms associated with antibiotic therapy, can make diagnosis extremely difficult. Patients with acute otitis media who fail to respond fully to treatment should be referred early for a specialist otology opinion.
Asunto(s)
Absceso Encefálico/complicaciones , Absceso Epidural/complicaciones , Trombosis del Seno Lateral/complicaciones , Mastoiditis/complicaciones , Enfermedad Aguda , Absceso Encefálico/diagnóstico por imagen , Niño , Absceso Epidural/diagnóstico por imagen , Humanos , Trombosis del Seno Lateral/diagnóstico por imagen , Masculino , Mastoiditis/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
The sensation of a foreign body in the throat when swallowing is a common and very discomforting symptom for those who experience it. Common causes are gastroesophageal reflux disease and possibly upper oesophageal dysmotility. This complaint may be dismissed as psychogenic when a cause for the problem is not readily apparent. We present two cases in which the patient had a foreign body sensation in the throat, associated with a dry swallow. The most helpful diagnostic procedure was careful examination of the hypopharynx and neck and flexible fibre-optic rhinolaryngoscopy. One case was treated with surgery of the neck and larynx to trim the medially projecting superior cornu of the thyroid cartilage. Surgery was successful in eliminating the symptoms. Although an uncommon finding, our experience is that symptoms due to a medially displaced thyroid cornu should be considered in the differential diagnosis as an important and surgically correctable cause of persistent foreign body sensation at the hyoid level in the neck.
Asunto(s)
Cuerpos Extraños/diagnóstico , Enfermedades de la Laringe/diagnóstico , Cartílago Tiroides , Trastornos de Deglución/etiología , Trastornos de Deglución/cirugía , Diagnóstico Diferencial , Esofagoscopía , Humanos , Enfermedades de la Laringe/cirugía , Masculino , Persona de Mediana Edad , Cartílago Tiroides/cirugía , Resultado del TratamientoRESUMEN
This is the last of the three review articles dealing with thyroid cancer. Over 90% of thyroid cancer is of the differentiated type associated with a very good 10-year disease-free survival rate. In contrast, the rare forms of thyroid cancer which comprise medullary thyroid cancer arising from parafollicluar C cells, Hurthle cell carcinoma, anaplastic carcinoma, thyroid lymphoma and squamous cell carcinoma are typically associated with a poorer survival rate. Management is based upon small retrospective cohort studies.
Asunto(s)
Carcinoma/terapia , Neoplasias de la Tiroides/terapia , Carcinoma/diagnóstico , Carcinoma/genética , Carcinoma de Células Escamosas/diagnóstico , Humanos , Linfoma/diagnóstico , Estadificación de Neoplasias/métodos , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/genéticaRESUMEN
This is the second review article on thyroid cancer dealing with the common differentiated types that comprise 90% of thyroid cancers. Despite clinical management guidelines offered by a number of organisations including the British Association of Otolaryngologists and Head and Neck Surgeon, The British Thyroid Association, The American Association Of Endocrinologists, The American Thyroid Association and the National Cancer Centre Network, debate regarding the management of differentiated thyroid cancer continues. This is because of the absence of good quality research evidence as a consequence of the natural history of this disease.
Asunto(s)
Carcinoma Papilar Folicular/terapia , Carcinoma Papilar/terapia , Neoplasias de la Tiroides/terapia , Humanos , Hipotiroidismo/prevención & control , Cuello/cirugía , Tiroidectomía/efectos adversos , Tiroidectomía/métodos , Tiroxina/uso terapéuticoRESUMEN
Thyroid cancer is uncommon with an estimated lifetime risk of 0.8% for women and 0.3% for men. The incidence appears to be increasing by 4% per year and is currently the eighth commonest cancer in women. Managing thyroid cancer is challenging, as no prospective randomised trials exist. Most of the information is derived from large patient cohorts in which therapy has not been randomly assigned. This is the first of the three review papers we have written on the management of thyroid cancer.
Asunto(s)
Neoplasias de la Tiroides/diagnóstico , Adulto , Biopsia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/terapiaRESUMEN
Cystic lesions of the larynx are most commonly benign. However, we report a case of non-Hodgkin's lymphoma (NHL) of the larynx which presented as a supraglottic cyst. This form of presentation has not been previously described in the medical literature.
Asunto(s)
Quistes/etiología , Enfermedades de la Laringe/etiología , Neoplasias Laríngeas/complicaciones , Linfoma de Células B/complicaciones , Linfoma de Células B Grandes Difuso/complicaciones , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales de Origen Murino , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Ciclofosfamida/administración & dosificación , Diagnóstico Diferencial , Doxorrubicina/administración & dosificación , Humanos , Inmunosupresores/uso terapéutico , Neoplasias Laríngeas/tratamiento farmacológico , Metástasis Linfática , Linfoma de Células B/tratamiento farmacológico , Linfoma de Células B Grandes Difuso/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Prednisona/administración & dosificación , Rituximab , Tomografía Computarizada por Rayos X , Vincristina/administración & dosificaciónRESUMEN
Otolaryngologic symptoms are common and patients presenting to the otolaryngologist will often be taking drugs for the treatment of unrelated diseases. As a doctor, one must not forget the potential of these drugs to cause otologic side effects and, in some cases, to be the cause of the presenting symptom. We performed a comprehensive search of the British National Formulary and Electronic Medical Compendium websites to classify the otologic side effects caused by drugs. Not all the data were found at both websites. We have compiled all the data together, subclassified them and produced a review of the otologic side effects of drugs, in table form.