Otolaryngology and the Global Burden of Disease.

The Global Burden of Disease (GBD) project provides longitudinal analysis of the global burden of otolaryngologic diseases by measuring the all-cause mortality, years of life lost, the years of life lived with disability, and disability-adjusted life years. Hearing loss burden is assessed overall and as sequelae of other diseases, such as otitis media or meningitis. Using these measures, we can appreciate the high prevalence and disability related to hearing loss globally. Other otolaryngologic diseases that contribute to the GBD include otitis media, cleft lip and palate, head and neck cancer, facial trauma, and oral disorders.

[The peculiar features of the microbial paysage and the problems of antibacterial therapy of the inflammatory ENT diseases in the patients presenting with diabetes mellitus]. / Osobennosti mikrobnogo peizazha i problemy antibakterial'noi terapii vospalitel'nykh zabolevanii LOR-organov u bol'nykh sakharnym diabetom.

This article is focused on the peculiar features of the ENT microbial paysage in the patients presenting with diabetes mellitus. We have examined a total of 310 patients including 145 suffering from the pyoinflammatory ENT diseases and concomitant diabetes mellitus. The study has demonstrated that the microbial biocenoses of the ENT organs in the diabetic patients are dominated by the potentially pathogenic and transitory microflora whereas the saccharolytic microflora and the non-fermentative bacteria (pseudomonades) concentrate in the foci of ENT inflammation. The spectrum of microorganism that occur in the areas of inflammation are shown to depend on the quality of compensation of diabetes mellitus.

Considerations for Management of Head and Neck Lymphatic Malformations in Children.

OBJECTIVE: There exist inherent problems with previously described classification schemes for head and neck lymphatic malformations in children and lack of guidance for management. An organization scheme and management recommendations are proposed to improve communication between health care providers. STUDY DESIGN: Consecutive patient series with a chart review of children with head and neck lymphatic malformations. SETTING: Tertiary-care, academic children's hospital. METHODS: Children with lymphatic malformations of the head and neck were included. A proposed organization system for head and neck lymphatic malformations in children was developed and compared to 2 others currently predominantly used, de Serres and Cologne Disease Score. RESULTS: Seventeen patients were identified, 7 boys and 10 girls. The mean age was 64.4 months (range 0.89-185.5). Nine patients (52.9%) were managed expectantly, 5 (29.4%) with sclerotherapy with 1 awaiting treatment (5.9%), and 2 (11.8%) with surgical excision. All children who underwent active treatment with surgery or sclerotherapy were managed successfully. No treatment-related complications were encountered, and no children managed with watchful waiting/expectant management experienced failure. The proposed staging system differed from the de Serres stage in 11 children (64.7%), with 9 (81.8%) being down staged and 2 (18.2%) up staged. Cologne Disease Score ranged from 2 to 10, with only 1 (5.9%) patient with a score of 3 or less (severe disease). CONCLUSIONS: Treatment recommendations in children with head and neck lymphatic malformations should be individualized. Weaknesses of currently used staging systems are discussed as well as considerations for management decisions.

[Capabilities of pharmacological correction with Reamberin the cerebrovascular disorders with ENT diseases of the elderly patients].

Endointoxication's syndrome and manifestations of immune deficiency observed among elderly patients with acute exacerbations of ENT diseases and concomitant cerebrovascular pathology. Reamberin in pathogenetic therapy arrests manifestations of intoxication and optimizes immunobiological homeostasis.

Transnasal esophagoscopy.

Since the mid 1900s, esophagoscopy has been performed under sedation or general anesthesia. With transnasal esophagoscopy (TNE), there has been a return to awake, in-office esophagoscopy. Technologic advances have allowed the advent of a ultrathin, flexible esophagoscope that is introduced transnasally, allowing esophagoscopy to be performed in unsedated patients. TNE correlates with conventional esophagoscopy (sedated, flexible esophagoscopy) in diagnostic capacity. Over time, as the benefits of TNE have become elucidated, the procedure has gained wider acceptance and continues to have its role in patient care defined.

[Expert opinions in ORL according to the new healthcare system act : rights for social compensation and the severely handicapped]. / HNO-Begutachtung nach der neuen Versorgungsmedizin-Verordnung : Soziales Entschädigungsrecht und Schwerbehindertenrecht.

The medically approved indications for social rights for compensation and the rights of severely disabled persons have been accepted for decades. After the introduction of the healthcare system act on 12th December 2008 these indications can no longer be applied. These rights now have the status of law. Since 1st January 2009 health disorders are not estimated according to the scale of disability but according to the scale of conditions due to injuries. The structure of the healthcare system act, the general modifications and certain consequences for the field of ORL will be described.

Development of guideline for rating the physical impairment of otolaryngologic field.

We develop a guideline for rating the physical impairment of otolaryngologic fields. Assessment of hearing disturbance and tinnitus required physical examination, pure tone audiometry, speech audiometry, impedance audiometry, brainstem evoked response audiometry, Bekesy audiometry, otoacoustic emission test, and imaging examination. History taking, physical examination, and radiological examination for the vestibular organ and brain, righting reflex test, electronystagmography, and caloric test are taken for evaluation of balance disorder. Olfactory function tests include University of Pennsylvania Smell Identification test, Connecticut Chemosensory Clinical Research Center test, T and T olfactometry and Korean Version of Sniffin's Sticks test. Medical history and physical examination is mandatory to evaluatezseverity of respiration difficulty. Examinations include flexible fiberoptic nasopharyngoscope, bronchoscopy, simple soft-tissue radiography films of upper airway and high resolution computed tomography. Evaluation of mastication and swallowing are history taking, physical examination, examination for upper jaw, lower jaw, and temporomandibular joint, dental examination and radiological studies. Endoscopy and esophagography are also needed. Voice disorder is evaluated based on physical examination, oral pharynx and larynx endoscopy, larynx stroboscopy, hearing assessment, laryngeal electromyography, sound analysis test, aerodynamic test, electroglottography, and radiologic examination. Articulation disorder is assessed by picture consonant articulation test. These are position articulation test, Lee-Kim Korean articulation picture and speech intelligibility assessment.

Estudio epidemiológico de las urgencias en un hospital / de tercer nivel / Epidemiological study of emergency services at a tertiary care center

Introducción y objetivo. La actividad asistencial en urgencias ha crecido de forma considerable en los últimos años. Probablemente, la inmigración y un incremento de la esperanza de vida han influido en este crecimiento. Muchos pacientes acuden buscando atención inmediata con tal de evitar listas de espera de especialidad en los centros de salud básicos. El principal objetivo es saber qué enfermedades en otorrinolaringología requieren asistencia médica urgente. Material y métodos. Es un estudio retrospectivo y descriptivo de 8.872 pacientes visitados en un año. Se analizaron algunas variables: edad, sexo, día de la semana, hora de llegada, destino final. Además, se hizo una distribución por categorías, dependiendo de la enfermedad presentada: otológica, rinológica, de faringe, laringe, cervical y otros. Resultados. La media diaria fue de alrededor de 25 pacientes por día. No hubo diferencias en cuanto al sexo. El lunes fue el día de la semana en el que se visitó a más pacientes. La enfermedad de oído fue la más atendida (32 %), seguida por la de faringe. De todas formas, la epistaxis (9,2 %) fue la entidad más común. El destino final en alrededor del 85 % fue el alta domiciliaria el mismo día. Conclusiones. El aumento de demanda de la atención urgente en los hospitales debe analizarse de forma concienzuda porque puede ser aún peor, teniendo en cuenta las tendencias epidemiológicas. Deben proponerse diferentes focos y nuevas políticas en cuanto a las urgencias

Introduction and objective. The number of patients attended in emergency rooms has gone up considerably in recent years. Immigration and an increase in life-expectancy have probably influenced this increase. A lot of patients come looking for immediate attention in order to avoid long waiting lists for specialist care at primary health-care facilities. The main objective is to know what pathologies in ear, nose and throat require urgent medical assistance. Material and methods. This is a retrospective descriptive study of 8,872 patients seen in a year. The variables analyzed were age, gender, day of the week, time of arrival, final result). In addition, a category distribution was made, depending on the pathology suffered: otological, rhinological, pharyngeal, laryngeal, cervical and others. Results. The daily mean was about 25 patients per day. There were no differences in distribution by gender. Monday was the day of the week when more patients were seen. Otological pathologies represented the most frequent reason for attending (32 %), followed by pharyngeal emergencies. However, epistaxis (9.2 %) was the most common entity. The final outcome for about 85 % of the patients was discharge to home on the same day. Conclusions. The rising demand for emergency attention in hospitals must be meticulously analyzed because it might become even worse, taking epidemiological trends into account. Different foci and new policies regarding emergency centres should be proposed

Development of Guideline for Rating the Physical Impairment of Otolaryngologic Field

We develop a guideline for rating the physical impairment of otolaryngologic fields. Assessment of hearing disturbance and tinnitus required physical examination, pure tone audiometry, speech audiometry, impedance audiometry, brainstem evoked response audiometry, Bekesy audiometry, otoacoustic emission test, and imaging examination. History taking, physical examination, and radiological examination for the vestibular organ and brain, righting reflex test, electronystagmography, and caloric test are taken for evaluation of balance disorder. Olfactory function tests include University of Pennsylvania Smell Identification test, Connecticut Chemosensory Clinical Research Center test, T and T olfactometry and Korean Version of Sniffin's Sticks test. Medical history and physical examination is mandatory to evaluatezseverity of respiration difficulty. Examinations include flexible fiberoptic nasopharyngoscope, bronchoscopy, simple soft-tissue radiography films of upper airway and high resolution computed tomography. Evaluation of mastication and swallowing are history taking, physical examination, examination for upper jaw, lower jaw, and temporomandibular joint, dental examination and radiological studies. Endoscopy and esophagography are also needed. Voice disorder is evaluated based on physical examination, oral pharynx and larynx endoscopy, larynx stroboscopy, hearing assessment, laryngeal electromyography, sound analysis test, aerodynamic test, electroglottography, and radiologic examination. Articulation disorder is assessed by picture consonant articulation test. These are position articulation test, Lee-Kim Korean articulation picture and speech intelligibility assessment.

[Renunciation of routine coagulation diagnostics before ENT operations in children. Results of a survey into the implementation of this recommendation in Dresden]. / Verzicht auf eine Routinegerinnungsdiagnostik vor HNO-Eingriffen bei Kindern. Ergebnisse einer Umfrage zur Umsetzung dieser Empfehlung in Dresden.

UNLABELLED: In Germany a recommendation was introduced by experts from several medical associations concerning the renunciation of preoperative coagulation diagnostics in ENT interventions in children with inconspicuous bleeding history and published in July 2006. In August 2007 a survey concerning the implementation of this recommendation was sent to all pediatricians and ENT doctors working in medical offices in Dresden. RESULT: The survey was answered by 23 (49%) paediatricians out of 47 who were contacted and 8 (33%) out of 24 ENT doctors. Fifteen pediatricians (65%) and 3 ENT doctors (38%) have implemented the recommendation consequently and 6 respectively 3 occasionally. Only 2 pediatricians and 2 ENT doctors did not accept the recommendation. Four paediatricians and 4 ENT doctors expressed their concerns with the implementation of recommendation. Since the implementation of this recommendation 3 children suffered from bleeding complications in ambulant ENT operations but in no case a coagulation disorder was present. CONCLUSION: The implementation of the recommendation at the regional level is practicable. Its acceptance is obviously higher in paediatricians than in ENT doctors.

ENT care of children and adolescents in the Brazilian public healthy system in three different municipalities.

UNLABELLED: The data base of ENT care in the Brazilian public health system (Sistema Unico de Saude - SUS) will help organize public health programs. AIM: The following items were investigated in patients aged up to 17 years attended in public health system outpatient units in the city of Mariana, in the ENT screening unit, UNIFESP-EPM, and in CISMISEL: 1) The main otorhinolaryngological diagnoses; 2) The most frequently required exams, drugs, and surgical procedures and their indications; 3) The jobs of parents; the number of siblings; and 4) A statistical analysis and comparison of data in each location. MATERIAL AND METHODS: We undertook a prospective study and a statistical analysis of variables that were gathered during the first visit. RESULTS: The age, the parents' salary, the number of siblings aged below 18 years, the presence of rhinitis, ears diseases, the exams, drugs and otological surgeries that were indicated were all statistically significant. CONCLUSION: The most common diagnosis was mouth breathing. The most common surgery was adenotonsillectomy. The most frequently requested exam was a lateral cranial radiograph. The number of unemployed parents, their poor salaries, and the number of siblings make it difficult for these patients to be treated in any facility other than the public heath system.

[ENT medicine and head and neck surgery in the G-DRG system 2008]. / Die HNO-Heilkunde, Kopf- und Hals-Chirurgie im G-DRG-System 2008.

BACKGROUND: Further developments in the German DRG system have been incorporated into the 2008 version. For ENT medicine and head and neck surgery significant changes concerning coding of diagnoses, medical procedures and concerning the DRG-structure were made. METHODS: Analysis of relevant diagnoses, medical procedures and G-DRGs in the versions 2007 and 2008 based on the publications of the German DRG institute (InEK) and the German Institute of Medical Documentation and Information (DIMDI). RESULTS: Changes for 2008 focussed on the development of DRG structure, DRG validation and codes for medical procedures. The outcome of these changes for German hospitals may vary depending on the range of activities. CONCLUSION: The G-DRG system has gained in complexity again. High demands are made on correct and complete coding of complex ENT and head and neck surgery cases. Quality of case allocation within the G-DRG system has been improved. For standard cases quality of case allocation is adequate. Nevertheless, further adjustments of the G-DRG system especially for cases with complex neck surgery are necessary.

Atendimento otorrinolaringológico do Sistema Único de Saúde de crianças e adolescentes em três municípios brasileiros / ENT care of children and adolescents in the Brazilian public healthy system in three different municipalities

A criação de um banco de dados sobre as demandas otorrinolaringológicas no SUS poderá fornecer informações para organizar estratégias de saúde e criar ou otimizar recursos do governo ou privados. OBJETIVOS: Determinar em pacientes até 17 anos de idade: 1) As principais doenças otorrinolaringológicas diagnosticadas; 2) Exames complementares mais solicitados; 3) Medicamentos mais prescritos; 4) Procedimentos ambulatoriais realizados e as indicações cirúrgicas; 5) Estado empregatício dos pais e o número de irmãos dependentes; 6) Comparar e analisar estatisticamente os dados nos locais estudados. MATERIAL E MÉTODO: Estudo prospectivo e análise estatística das variáveis obtidas nas primeiras-consultas na Policlínica de Mariana, na sede Consórcio Intermunicipal de Saúde da Microrregião de Sete Lagoas e na Triagem da Otorrinolaringologia da UNIFESP-EPM. RESULTADOS: Há diferenças estatisticamente significativas quanto às variáveis idade, média salarial dos pais empregados, número de irmãos até 17 anos, rinite, doenças otológicas, exames solicitados, prescrições e indicações de cirurgias micro-otológicas. CONCLUSÕES: O diagnóstico mais encontrado foi respiração oral. O exame complementar e a cirurgia mais indicados foram a radiografia de cavum e a adenoamigdalectomia. O nível de desemprego, a baixa média salarial e o número de dependentes na família dificultam tratamentos que não estejam disponíveis na rede pública de saúde.

The data base of ENT care in the Brazilian public health system (Sistema Unico de Saude - SUS) will help organize public health programs. AIM: The following items were investigated in patients aged up to 17 years attended in public health system outpatient units in the city of Mariana, in the ENT screening unit, UNIFESP-EPM, and in CISMISEL: 1) The main otorhinolaryngological diagnoses; 2) The most frequently required exams, drugs, and surgical procedures and their indications; 3) The jobs of parents; the number of siblings; and 4) A statistical analysis and comparison of data in each location. MATERIAL AND METHODS: We undertook a prospective study and a statistical analysis of variables that were gathered during the first visit. RESULTS: The age, the parents' salary, the number of siblings aged below 18 years, the presence of rhinitis, ears diseases, the exams, drugs and otological surgeries that were indicated were all statistically significant. CONCLUSION: The most common diagnosis was mouth breathing. The most common surgery was adenotonsillectomy. The most frequently requested exam was a lateral cranial radiograph. The number of unemployed parents, their poor salaries, and the number of siblings make if difficult for these patients to be treated in any facility other than the public heath system.

[Case allocation of extensive operations on head and neck within the German DRG system 2004-2007: what is the net result of the continued developments in case allocation?]. / Analyse der Abbildungsqualität grosser operativer Eingriffe an Kopf und Hals in den G-DRG-Systemen 2004-2007: Was hat die Weiterentwicklung der Fallpauschalen gebracht?

BACKGROUND: When the German DRG system was implemented there was some doubt about whether patients with extensive head and neck surgery would be properly accounted for. Significant efforts have therefore been invested in analysis and case allocation of those in this group. The object of this study was to investigate whether the changes within the German DRG system have led to improved case allocation. METHODS: Cost data received from 25 ENT departments on 518 prospective documented cases of extensive head and neck surgery were compared with data from the German institute dealing with remuneration in hospitals (InEK). Statistical measures used by InEK were used to analyse the quality of the overall system and the homogeneity of the individual case groups. RESULTS: The reduction of variance of inlier costs improved by about 107.3% from the 2004 version to the 2007 version of the German DRG system. The average coefficient of cost homogeneity rose by about 9.7% in the same period. Case mix index and DRG revenues were redistributed from less extensive to the more complex operations. Hospitals with large numbers of extensive operations and university hospitals will gain most benefit from this development. CONCLUSION: Appropriate case allocation of extensive operations on the head and neck has been improved by the continued development of the German DRG system culminating in the 2007 version. Further adjustments will be needed in the future.

[ENT and head and neck surgery in the German DRG system 2007]. / HNO-Heilkunde, Kopf- und Hals-Chirurgie im G-DRG-System 2007.

BACKGROUND: The German DRG system has been further developed into version 2007. For ENT and head and neck surgery, significant changes in the coding of diagnoses and medical operations as well as in the the DRG structure have been made. RESULTS: New ICD codes for sleep apnoea and acquired tracheal stenosis have been implemented. Surgery on the acoustic meatus, removal of auricle hyaline cartilage for transplantation (e. g. rhinosurgery) and tonsillotomy have been coded in the 2007 version. In addition, the DRG structure has been improved. Case allocation of more than one significant operation has been established. CONCLUSION: The G-DRG system has gained in complexity. High demands are made on the coding of complex cases, whereas standard cases require mostly only one specific diagnosis and one specific OPS code. The quality of case allocation for ENT patients within the G-DRG system has been improved. Nevertheless, further adjustments of the G-DRG system are necessary.

[ENT relevant changes in the German OPS Procedure Classification System for 2006]. / HNO-relevante Anderungen des Operations- und Prozedurenschlüssels (OPS) ab 2006.

BACKGROUND: Classification of surgical and medical procedures is of increasing relevance for health care financing. From this viewpoint, classification according to the German "Operations- und Prozedurenschlüssel" (OPS) was frequently inadequate so far. METHODS: In the course of a comprehensive DRG evaluation project, deficits of the economic classification of ENT-medicine were identified. Based on these findings, proposals for further improvement of the OPS were developed. RESULTS: An improper medical economic classification was identified for common surgical procedures on middle ear, nose and paranasal sinuses, and for coding of prosthetic voice restoration. In agreement with the German Institute for Medical Documentation and Information (DIMDI) the OPS was revised accordingly. CONCLUSIONS: Significant modifications of the OPS will take place at January 1 (st) 2006, which are of great impact for health care financing by the G-DRG-System and in the context of outpatient surgery.