Prediction of a Difficult Airway Using the ARNE Score and Flexible Laryngoscopy in Patients with Laryngeal Pathology.

Background and Objectives: The ARNE score was developed for the prediction of a difficult airway for both general and ear, nose and throat (ENT) surgery with a universal cut-off value. We tested the accuracy of this score in the case of laryngeal surgery and provided an insight into its effects in combination with flexible laryngoscopy. Materials and Methods: This prospective pilot clinical study included 100 patients who were being scheduled for microscopic laryngeal surgery. We calculated the ARNE score for every patient, and flexible laryngoscopy was provided preoperative. Difficult intubation was assessed according to the intubation difficulty score (IDS). Results: A total of 33% patients had difficult intubation according to the IDS. The ARNE score showed limited accuracy for the prediction of difficult intubation in laryngology with p < 0.0001 and an AUC of 0.784. Flexible laryngoscopy also showed limitations when used as an independent parameter with p < 0.0001 and an AUC of 0.766. We defined a new cut-off value of 15.50 for laryngology, according to the AUC. After the patients were divided into two groups, according to the new cut-off value and provided cut-off value, the AUC improved to 0.707 from 0.619, respectively. Flexible laryngoscopy improved the prediction model of the ARNE score to an AUC of 0.882 and of the new cut-off value to an AUC of 0.833. Conclusions: It is recommended to use flexible laryngoscopy together with the ARNE score in difficult airway prediction in patients with laryngeal pathology. Also, the universally recommended cut-off value of 11 cannot be effectively used in laryngology, and a new cut-off value of 15.50 is recommended.

Impact of Sensorineural Hearing Loss during the Pandemic of COVID-19 on the Appearance of Depressive Symptoms, Anxiety and Stress.

BACKGROUND: The incidence of hearing loss is constantly increasing and according to the World Health Organization, by 2050, 900 million people will suffer from hearing loss. The main Objective of the study was to determine the differences between the severity of the symptoms of stress, anxiety and depression in participants with varying degrees of sensorineural hearing loss during the COVID-19 pandemic. An additional aim was to examine the extent and manner in which protective face masks impact the communication of people with hearing loss. Matrials and Methods: A cross-sectional study was conducted, which included 160 patients (81 men and 79 women) with bilateral sensorineural hearing loss. The patients' age range was 50 to 80 years. Depending on the degree of hearing loss or pure-tone threshold, the participants were divided into four groups: mild hearing loss, moderate hearing loss, severe hearing loss and profound hearing loss. The research used the Depression, Anxiety and Stress Scale (DASS-21) and a questionnaire in which the participants reported whether surgical face masks (medical three-layer masks) worn by speakers makes communication difficult, to what extent and in what way. RESULTS: The average age of the patients was 67.97 ± 8.16. A significant correlation was found between the degree of hearing loss and communication difficulties caused by the use of protective face masks (p < 0.001). For patients with severe and profound hearing loss, communication is significantly more difficult (50.0% and 45.0% respectively) when the interlocutor wears a face mask. There is a significant correlation between the degree of hearing loss and the way in which communication is made more difficult when the interlocutor wears a face mask (p < 0.001). A statistically significant difference was determined between the degrees of hearing loss in all measured subscales: stress (p = 0.024), anxiety (p = 0.026) and depression (p = 0.016). CONCLUSIONS: We have determined that face masks used during the COVID-19 pandemic significantly hamper communication among the study groups (p = 0.007) and there is a significant correlation between the degree of sensorineural hearing loss and the presence of symptoms in all three DASS-21 subscales, meaning that the symptoms of stress, anxiety and depression were more intense in severe and profound hearing loss.

The Effects of Melatonin on Oxidative Stress Parameters and DNA Fragmentation in Testicular Tissue of Rats Exposed to Microwave Radiation.

BACKGROUND: Microwaves from mobile phones are one of the environmental toxicants that are capable of compromising male fertility by inducing oxidative stress and apoptosis in the testes. Melatonin is a lipophilic tryptophan indole amine and a potent antioxidant. OBJECTIVES: The aim of the study was to evaluate the effect of melatonin treatment on oxidative stress parameters and DNA fragmentation in the testicular tissue of rats exposed to microwave radiation (4 h/day). MATERIAL AND METHODS: Adult Wistar rats were divided in 4 groups: I--treated with saline; II--treated with melatonin; III--exposed to microwaves; IV--exposed to microwaves and treated with melatonin. The melatonin (2 mg/kg ip) was administered daily. The animals were sacrificed after 20, 40 and 60 days. RESULTS: Melatonin treatment prevented previously registered increases in malondialdehyde after only 20 days. Furthermore, it reversed the effects of microwave exposure on xanthine oxidase (after 40 days) and acid-DNase activity (after 20 days). However, neither protein carbonyl content nor catalase and alkaline Dnase activity were changed due to melatonin treatment. CONCLUSIONS: Melatonin exerts potent antioxidant effects in the testes of rats exposed to microwaves by decreasing the intensity of oxidative stress; it also reduces DNA fragmentation.

Primary and salvage total laryngectomy. Influential factors, complications, and survival.

PURPOSE: In this retrospective study we analysed patients with advanced squamous cell carcinoma of the larynx and hypopharynx treated with primary total laryngectomy (PTL) between 1990 and 2007. METHODS: The patients were treated by classical PTL, radiotherapy 60-70 Gy, concomitant radio and chemotherapy (cisplatin and 5-fluorouracil) or salvage total laryngectomy (STL). They were followed up for 5 years and complications, survival, residual/recurrent disease and metastases were registered. RESULTS: STL after previous radiotherapy (STL-pRT), and after chemoradiotherapy (STL-pCTRT) caused more frequent local complications than PTL. Five-year disease-free survival (DFS) rate was significantly influenced by TNM stage and localization of the primary laryngeal tumor. For laryngeal cancer it was: 61.3% for PTL, 54.1% for STL-pC-TRT, and 47.6% for STL-pRT. Incomplete responders to initial treatment had low survival rate. PTL for hypopharyngeal carcinoma and particularly salvage laryngectomy after chemoradiotherapy were associated with more frequent local complications. The 5-year DFS for hypopharyngeal cancer was lower than for laryngeal cancer. CONCLUSION: PTL still offers the best survival rate with low complications for advanced laryngeal and hypopharyngeal squamous cell carcinoma. STL causes more frequent local complications, especially after chemoradiotherapy. Addition of chemotherapy to radiotherapy increases the survival. Five-year DFS rate depends on TNM stage and localization of the primary tumor.

Influential factors, complications and survival rate of primary and salvage total laryngectomy for advanced laryngeal cancer.

This is a retrospective review of patients with advanced malignant neoplasms of the larynx treated with total laryngectomy. 387 total laryngectomies for advanced squamous cell carcinoma of larynx performed in the period between 1995 and 2007 were analyzed. Primary total laryngectomy (PRT) was performed in 316 patients, while initial radiotherapy radiotherapy (60-70 Gy) and concomitant chemotherapy (cisplatin-5 fluorouracil) with radiotherapy were applied in totally 71 patients who later received salvage total laryngectomy (STL). All the laryngectomies were performed by four surgeons, using the same routine surgical technique. Postoperative clinical examination was made every three months during five years. We documented the occurrence of: local and general complications, survival rate, residual and recurrent disease, lymph node metastasis, and other changes. Salvage total laryngectomy after previous radiotherapy (STL-pRT) and after chemoradiotherapy (STL-pCTRT) caused more frequent local complications than primary total laryngectomy (PTL). TNM stage and localization of primary laryngeal tumor had significant influence on five year survival rate. It amounted: 61.4% for PTL, 52.6% for STL-pCTRT, and 48.5% for STL-pRT. Incomplete response to initial treatment produced low survival rate. Salvage total laryngectomy caused more frequent local complications, especially after chemoradiotherapy when compared to primary laryngectomy. Survival rate was increased when chemotherapy is added to radiotherapy. Five year survival rate depended on TNM stage and localization of primary tumor.

Head and neck cancer surgery in elderly: complications and survival rate.

The number of aged patients with head and neck cancer is increasing. The aim of this study was to evaluate the outcome of elderly patients with head and neck cancer undergoing surgery. Retrospective analysis of a series of 1509 consecutive patients separated in two groups regarding their age: younger than 70 and older than 70 years, with head and neck tumors treated surgically was performed. Pre-existent comorbid conditions, immediate and long-term surgical and medical complications were analyzed. Postoperative surgical and medical complications were scored according to their severity. During the ten years period the group of patients older than 70 years comprised of 356 patients, or 23.6%. Primary site tumor distribution was similar in both patients groups. Cancer stage grouping was equally distributed between older patients and the other patients. We found the biggest incidence of postoperative complications for hypopharyngeal, than laryngeal, and oropharyngeal cancer. Swallowing difficulties were documented in 16.5% for hypopharyngeal, 10.0% for laryngeal, and 7.3% for oropharyngeal site. Aspiration was present in 3.1% to 1.8%, respectively. Survival rate was similar for different cancer locations, and was more influenced by the advancement of tumor. Postoperative complications are related to tumor location, and extent of the disease. According to the results of our study head and neck cancer in elderly should be treated by conventional protocols.

Stridor as initial clinical presentation of tracheal chondroma / El estridor como presentación clínica inicial del condroma traqueal

Chondromas are benign cartilaginous tumours that are uncommon in the head and neck region. Only few cases of chondroma have been reported in the trachea. We present a 70-year-old patient who presented clinically with severe dyspnoea requiring urgent tracheotomy. An oval, expansive, well-delineated tracheal tumour was evident on magnetic resonance imaging. The mass was removed surgically in its entirety, preserving tracheal rings, and the histopathological diagnosis was chondroma. The patient was decannulated after 2 months, and was followed for 3 years. Urgent tracheotomy is an unusual initial clinical manifestation of this infrequent tumour. Surgical options and the choice of therapy in this case are discussed (AU)

Los condromas constituyen tumores cartilaginosos benignos que son infrecuentes en las regiones de cabeza y cuello. Sólo unos pocos casos de condroma se han producido en la tráquea. Presentamos un paciente de 70 años que se presentó clínicamente con disnea, que precisaba una traqueotomía urgente. En la imagen de la resonancia magnética se reveló un tumor traqueal oval, expansivo y bien delineado. La masa fue íntegramente extirpada mediante cirugía, conservándose los anillos traqueales, y el diagnóstico histopatológico resultó ser un condroma. El paciente fue desintubado a los dos meses, realizándose un seguimiento durante tres años. La traqueotomía de urgencia constituye una infrecuente manifestación clínica inicial de este tumor poco frecuente. En este artículo se tratan las opciones quirúrgicas y la elección de terapia (AU)

Stridor as initial clinical presentation of tracheal chondroma.

Chondromas are benign cartilaginous tumours that are uncommon in the head and neck region. Only few cases of chondroma have been reported in the trachea. We present a 70-year-old patient who presented clinically with severe dyspnoea requiring urgent tracheotomy. An oval, expansive, well-delineated tracheal tumour was evident on magnetic resonance imaging. The mass was removed surgically in its entirety, preserving tracheal rings, and the histopathological diagnosis was chondroma. The patient was decannulated after 2 months, and was followed for 3 years. Urgent tracheotomy is an unusual initial clinical manifestation of this infrequent tumour. Surgical options and the choice of therapy in this case are discussed.

Changes in auditory ossicles in rheumatoid arthritis: scanning electron microscopic study.

The aim of this study was to define the existence of surface changes on auditory ossicles caused by rheumatoid arthritis. The study comprised of nine pairs of auditory ossicles (mallei and incudes) from autopsy of patients with rheumatoid arthritis, and five pairs of ossicles from persons without RA, taken during autopsies. The specimens were studied with JEOL JSM 5300 type scanning electron microscope. Surface changes of auditory ossicles were defined, affected areas were calculated, and expressed in percentage of total surface. Changes in auditory ossicles in patients with rheumatoid arthritis are significantly higher than in control ossicles, both on ossicular surface and articulations. Increased lysis of incudes, especially in the region of long propagation, corresponds to vascular damage. Articular degeneration is also present, indicating specific rheumatoid alteration. Both changes are statistically more intense in cases with longer duration of disease. In conclusion, rheumatoid arthritis reduces vascularity of auditory ossicles and causes degeneration of articular surfaces.