[Superior semicircular canal dehiscence as a cause of hearing loss]. / "Kolmas ikkuna" kuulonheikentymän taustalla.

Superior semicircular canal dehiscence can be the cause of hearing loss and vertigo. Typical findings are conductive hearing loss and hyperacusis to bone-conducted sounds. Also acute pressure- and sound-evoked vestibular symptoms may occur. We describe a middle-aged patient with a conductive hearing loss. A few basic examinations led to suspicion of superior canal dehiscence. Computerized tomographic (CT) scan revealed a pathologic third window in the superior semicircular canal.

[Lump in the throat]. / Pala kurkussa.

A sensation of a lump in the throat will often cause fear of tumor. Underlying the symptom is only seldom a tumor, which is, however, malignant in about 97 to 99% of cases of hypopharyngeal occurrence. Excessive alcohol consumption and smoking constitute the their greatest risk factors. We present a patient case relating to a rare benign tumor of the hypopharynx (giant fibrovascular polyp, GFP).

Celecoxib and ketoprofen for pain management during tonsillectomy: a placebo-controlled clinical trial.

OBJECTIVE: To evaluate the efficacy and safety of celecoxib and ketoprofen in pain management during tonsillectomy in 120 patients. STUDY DESIGN AND SETTING: The study was randomized, double-blind, and placebo-controlled with parallel groups. Sixty minutes before anesthesia induction and 12 hours after, the patients received a 200-mg celecoxib, a 100-mg ketoprofen, or a placebo capsule. After discharge, patients were prescribed either celecoxib or ketoprofen capsules to be taken every 12 hours. RESULTS: During the first 24 hours, the need for rescue analgesic was less in the ketoprofen-group (5 [1-9]) doses (median [range]) than in the placebo-group (6 [1-13]) ( P = 0.021), but similar to the celecoxib-group (5 [2-14]). After discharge, the cessation of pain during eating occurred earlier in the celecoxib-treated patients, after 10 (1-17) days, than in the ketoprofen-treated patients, after 12 (1-21) days, ( P = 0.008). One celecoxib-treated patient and 6 ketoprofen-treated patients ( P = 0.013) needed electrocautery to stop postoperative bleeding. CONCLUSION: Ketoprofen provided a better initial analgesic efficacy but after discharge the recovery with celecoxib was faster and the incidence of secondary hemorrhages was lower. SIGNIFICANCE: Celecoxib seems to be more effective and safe than ketoprofen for pain management after discharge in patients with tonsillectomy.

Carcinoid tumor of the middle ear.

Although carcinoid tumors are labeled as neuroendocrine tumors they can also originate in tissue lacking neuroendocrine cells, such as that in the middle ear. Symptoms of a carcinoid tumor in the middle ear are common ear symptoms such as fullness, pain and hearing loss. Carcinoid tumors have also been considered to be slow-growing. Both these aspects can easily lead to a relatively late diagnosis of carcinoid tumor of the middle ear. The diagnosis is made histologically, and the tumor is primarily treated surgically. In the follow-up of patients, octreotide scanning has proved to be a sensitive method in cases of both recurrence and metastasis. Our patient was a 34-year-old, otherwise healthy female with left-sided acute otitis media and facial palsy in her left ear. She had also suffered from the same symptoms 4 years earlier. She was treated with an operation, and the histologic diagnosis was a carcinoid tumor. In the follow-up of the patient we used octreotide scanning.

Ketoprofen for postoperative pain after uvulopalatopharyngoplasty and tonsillectomy: two-week follow-up study.

OBJECTIVE: In our previous study, we reported that both uvulopalatopharyngoplasty (UPPP) and tonsillectomy are associated with unacceptable intense pain during the first 24 hours after surgery. To investigate the pain progression at home, we followed the same 53 patients for 14 days after surgery. Twenty-two patients underwent tonsillectomy and 31 patients underwent UPPP. STUDY DESIGN: A prospective, longitudinal, parallel-group study was conducted. METHODS: Beginning on the first postoperative day, the patients were allowed to use 50 mg ketoprofen capsules at a dosage of 5 mg/kg/24 hr. The patients evaluated their own pain four times a day for the first 5 days. Two weeks after the surgery during a follow-up visit patients reported the present pain; and a total consumption of analgesics, and all adverse events for 14 days. RESULTS: Patients in both study groups had significant pain, especially in the morning, for the first week after surgery. In half of the patients, severe pain interfered with eating and sleeping, and in one third of the patients, the pain lasted 2 weeks or longer. The need for ketoprofen was significantly higher after UPPP than that after tonsillectomy (P = 0.001). One patient after tonsillectomy and 3 patients after UPPP needed electrocautery to stop secondary bleeding. CONCLUSIONS: Both UPPP and tonsillectomy are associated with intense postoperative pain. Standard ketoprofen capsules are too short-acting to ensure undisturbed sleep.

Pain intensity after laseruvulopalatoplasty and tonsillectomy.

OBJECTIVE: The first objective of this study was to evaluate pain intensity and opioid consumption during the first 24 hours after uvulopalatoplasty and tonsillectomy in the hospital, and the second was to evaluate pain intensity and its progression during the first 2 weeks after surgery at home. STUDY DESIGN AND SETTINGS: In a prospective parallel group study, 51 patients with uvulopalatoplasty or tonsillectomy were studied. Ketoprofen, a nonsteroidal antiinflammatory drug, and fentanyl citrate, an opioid, were used as analgesics. RESULTS: Despite ketoprofen infusion and free access to a patient-controlled pump with fentanyl citrate for rescue analgesia, inadequate pain relief was common both after uvulopalatoplasty (35%) and after tonsillectomy (28%) during the first 24 hours after surgery. The consumption of fentanyl citrate was similar after both operations. At home, pain intensity was highest in the mornings during the first 5 days, and 10 patients had some pain still after 2 weeks. Also at home, high pain scores were reported commonly in both groups. CONCLUSION: Significant pain after uvulopalatoplasty and tonsillectomy lasted for several days. Ketoprofen in the commercial capsule form proved to be too short acting for overnight pain relief. SIGNIFICANCE: Pain treatment in patients with uvulopalatoplasty and tonsillectomy should be improved to allow patients a peaceful recovery after surgery.

Nimesulide versus Ibuprofen for Postoperative Tonsillectomy Pain : A Double-Blind, Randomised, Active Comparator-Controlled Clinical Trial.

BACKGROUND AND OBJECTIVE: Nonsteroidal anti-inflammatory drugs are effective analgesics but their use during tonsillectomy is controversial because of the risk of postoperative bleeding. The aim of this study was to compare the analgesic efficacy and safety of nimesulide, a preferential cyclo-oxygenase type-2 inhibitor, with ibuprofen in the treatment of pain after tonsillectomy. STUDY DESIGN: A prospective, double-blind, randomised clinical trial. PATIENTS AND METHODS: A total of 80 consenting generally healthy patients, aged 14-58 years, undergoing tonsillectomy were randomly assigned to receive either nimesulide 100mg or ibuprofen 800mg orally 60 minutes before surgery. Subsequent doses of the same study medication were administered at 12-hour intervals for the first 7 days, and thereafter when needed. During the first 24 postoperative hours in hospital oxycodone was used for rescue analgesia, and after discharge patients were allowed to use a paracetamol-codeine combination for breakthrough pain. Recovery was recorded up to 3 weeks after surgery. RESULTS: The need for rescue analgesia during the first 24 hours was similar in the two study groups; 0-7 doses (mean +/- SD 3.3 +/- 1.7 doses) in the nimesulide group and 0-11 doses (3.3 +/- 2.4 doses) in the ibuprofen group. After discharge significant differences were found between the two study groups in favour of the nimesulide-treated patients. Cessation of significant pain while swallowing occurred after 3-19 (10.9 +/- 3.8) days in the nimesulide group versus 7-20 (12.9 +/- 3.3) days in the ibuprofen group (p = 0.041), and return to normal daily activities occurred after 3-21 (10.3 +/- 4.9) days in the nimesulide group versus after 3-19 (12.7 +/- 4.2) days in the ibuprofen group (p = 0.048). At 3 weeks, six of 33 patients in the nimesulide group versus 15 of 37 patients in the ibuprofen group had pain during swallowing (p = 0.049). One patient (3%) in the nimesulide group and five patients (12%) [p = 0.22] in the ibuprofen group needed electrocautery to stop postoperative bleeding. CONCLUSION: Oral nimesulide was as effective as ibuprofen in pain management after tonsillectomy, and nimesulide improved the recovery after discharge.