SCUBA Medicine for otolaryngologists: Part I. Diving into SCUBA physiology and injury prevention.

OBJECTIVES: Introduce pertinent self-contained underwater breathing apparatus (SCUBA) physiology and corresponding terminology. Appreciate the scope of diving and related otolaryngological injury. Illustrate pathophysiologic mechanisms for diving injuries. Summarize strategies for ear, paranasal sinus, and lung barotrauma prevention, including medical optimization and autoinsufflation techniques. METHODS: We conducted a review of the available medical and diving literature in English, German, Spanish, Italian Turkish, and French to determine the degree of evidence or lack thereof behind recommendations for treating SCUBA divers. The databases of PubMed, Ovid Medline, and the Cochrane library, as well available textbooks, were queried for relevant data. RESULTS: Divers are subjected to large pressure gradients within the first few meters of descent. This can lead to gas embolism formation as well as barotrauma secondary to gas expansion/compression in potential closed spaces such as the middle ear, paranasal sinuses, and lungs. Physicians can minimize the risk of injury by counseling patients regarding proper equalization and descent/ascent techniques, and optimizing sinonasal and eustachian tube function. The use of decongestants is controversial. CONCLUSIONS: Diving is an increasingly popular sport with predominantly otolaryngologic manifestations of injury and disease. Treating SCUBA divers requires a firm understanding of how physiology is altered underwater. This review presents the relevant background information using illustrations to understand the environmental forces acting on divers and how to prevent injury. Laryngoscope, 130:52-58, 2020.

Immunoglobulins in Neonates with Rhesus Hemolytic Disease of the Fetus and Newborn: Long-Term Outcome in a Randomized Trial.

OBJECTIVE: Prophylactic intravenous immunoglobulin (IVIg) does neither reduce the need for exchange transfusion nor the rates of other adverse neonatal outcomes in neonates with rhesus hemolytic disease of the fetus and newborn (rhesus HDFN) according to our randomized controlled trial analysis. Our objective was to assess the long-term neurodevelopmental outcome in the children included in the trial and treated with either IVIg or placebo. METHODS: All families of the children included in the trial were asked to participate in this follow-up study. The long-term neurodevelopmental outcome in children at least 2 years of age was assessed using standardized tests. The primary outcome was the incidence of neurodevelopmental impairment defined as at least one of the following: cerebral palsy, severe cognitive and/or motor developmental delay (with a test score of less than -2 SD), bilateral deafness or blindness. RESULTS: Sixty-six of the 80 children (82.5%) who had been recruited to the initial randomized controlled trial participated in the follow-up study. The children were assessed at a median age of 4 years (range 2-7). The median cognitive score was 96 (range 68-118) in the IVIg group and 97 (range 66-118) in the placebo group (p = 0.79). There was no difference in the rate of neurodevelopmental impairment between the IVIg and the placebo group [3% (1/34) vs. 3% (1/32); p = 1.00]. CONCLUSIONS: The long-term neurodevelopmental outcome in children treated with IVIg was not different from that in children treated with placebo. Standardized long-term follow-up studies with large enough case series and sufficient power are needed to replicate these findings.

The Knowledge of the Role of Papillomavirus-Related Head and Neck Pathologies among General Practitioners, Otolaryngologists and Trainees. A Survey-Based Study.

OBJECTIVES: The aim of the survey was to introduce knowledge of HPV's role in head and neck pathologies to general physicians (GPs), otorhinolaryngologists (ENTs) and newly graduated doctors, as well as to promote HPV-related diseases prevention. STUDY DESIGN: Cross-sectional study. METHODS: Self-designed questionnaire was sent to 2100 doctors. A total of 404 doctors, including 144 ENTs, 192 GPs and 68 trainees, responded. RESULTS: The majority of ENTs (86.8%) had contact with recurrent respiratory papillomatosis (RRP) and oropharyngeal cancers (OPCs) patients; in contrast, the majority of GPs (55.7%) did not (p = 0.00). The knowledge of HPV aetiology of cervical cancer versus OPCs and RRP was statistically higher. 7% of ENTs, 20% of GPs and 10% of trainees had not heard about HPV in oropharyngeal diseases. Women had greater knowledge than men. Both in the group of GPs and ENTs, 100% of respondents had heard about the impact of vaccination on the reduction of cervical cancer incidence. Only 39.11% of respondents had heard about the possibility of using vaccination against HPV in RRP-ENT doctors significantly more often than GPs and trainees (p = 0.00). Only 28.96% of physicians had heard about the potential value of HPV vaccination in preventing OPCs, including 44.44% of ENT doctors, 23.44% of GPs and 11.76% of trainees (p = 0.00). The doctors from district hospitals showed lower level of knowledge compared with clinicians (p = 0.04). CONCLUSIONS: The different levels of knowledge and awareness of HPV issues highlight the need for targeted awareness strategies in Poland with implementation of HPV testing and vaccination. The information should be accessible especially to those with lower education levels: ENTs from small, provincial wards, GPs from cities of < 200,000 inhabitants and older physicians. The incorporation of HPV issues into the studies curriculum would be fruitful in terms of improving the knowledge of trainees.

[The system of prophylaxis in otorhinolaryngology].

This publication is focused on the modern basis behind the system for the prevention of acute and chronic ENT diseases with special reference to the compliance with the principles of primary, secondary, and tertiary prophylaxis. The special emphasis is laid on the role of the otorhinolaryngologist in the formation of the healthy lifestyle, organization of regular medical examination and rehabilitative treatment of the population. A detailed description of the activities of an otorhinolaryngologist in the framework of mass prophylaxis programs is presented. The main drawbacks of the current normative-regulatory documentation are discussed. It is concluded, based on the analysis of ENT morbidity among the Russian population, that the participation of otorhinolaryngologists is indispensable at the first, second, and third stages of regular medical examination. The modern regulations for the prophylaxis of occupational ENT diseases are considered.

[A practically orientated clinical HIV update for ENT physicians]. / Praktisch orientiertes klinisches HIV-Update für HNO-Ärzte.

Basic knowledge concerning the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) is useful for ENT physicians. Although HIV patients are usually stably asymptomatic nowadays due to modern therapy, HIV often manifests in ENT symptoms, such as neck lumps, sore throat, difficulty swallowing and dysgeusia. After infection, an initial increase in viral load can cause, among other symptoms, oral ulcers and pharyngitis. Once the immune system is compromised by the attack on CD4 lymphocyte cells, HIV-related diseases can occur: oral mycoses (particularly candidosis) and viral infections (including warts), aphthous ulcers, gingivitis, salivary gland diseases and malignancies (e. g. intraoral Kaposi's sarcoma). Neck lymphadenopathy is frequent. Markers of disease severity are the clinical symptoms, viral load and CD4 helper cell count. HIV treatment (antiretroviral therapy, ART) is a combination of at least three antiviral drugs.

Replica a la carta «Comentario sobre las infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos» / Reply to the letter «Comments on peritonsillar infections: a prospective study of 100 consecutive cases»

No disponible

[The influence of the defects and deformities in the intranasal septum on the main functions of the nose (preliminary report)].

AIM OF THE STUDY: to estimate the influence of the defects and deformities in the intranasal septum on the main functions of the nose and therefore on the state of the upper respiratory tract and the ears. METHODS: A total of 180 patients suffering deformation of the nasal septum were available for the examination. The study included the evaluation of breath characteristics, excretory and inspiratory functions of the nose compared with control with the use of the conventional methods including rhinometry. RESULTS: The patients presenting with the defects and deformities in the intranasal septum were found to have nasal breathing problems, impaired sense of smell, disturbances of the excretory, inspiratory, air-transporting, and air-heating functions of the nose. Comparative analysis of laryngeal, pharyngeal, tracheal, bronchial, and pulmonary disorders has demonstrated the significant differences in the frequency and duration of these diseases and in the efficacy of their treatment between the patients of the study and control groups. It is concluded that the early recovery of nasal functions, in the first place the respiratory one, is an important precondition for the efficacious prevention of various catarrhal and other laryngeal diseases of the larynx, pharynx, trachea, bronchi, lungs, and ears.

[Epidemiology and prophylaxis of ENT diseases in the cadets of the Nakhimov Naval School].

The objective of the present study was to determine the prevalence of otorhinolaryngological morbidity among the cadets of the Nakhimov Naval School and propose the effective measures for its reduction and prevention. A total of 335 children at the age from 11 to 17 years were available for the examination. The analysis of otorhinolaryngological morbidity during September and October 2011 revealed the high frequency of acute respiratory diseases (46 cases) and maxillary sinus symptoms (12 cases). The newly recruited children accounted for 40% of the affected patients. The results of the screening carried out in the military educational institution suggest the necessity of improvement of the quality of primary medical screening, timely diagnostics and correction of pathological conditions. They can be used to formulate the long-range objectives for the improvement of individual recommendations for the medical observation of the cadets presenting with chronic ENT diseases.

[Prophylaxis of acute respiratory infections in children's collectives: results of treatment with nasal and nasopharyngeal irrigation].

The aim of this paper is to report the results of a multicenter open randomized clinical study of the efficacy of nasal and nasopharyngeal irrigation for the prevention of seasonal morbidity due to acute respiratory infections (ARIs) in the groups of preschool and school children. A total of 2386 children attending secondary schools and 519 ones attending kindergartens were examined. The study has demonstrated that irrigation of the nasal cavity and nasopharynx efficaciously reduces (by 2.4-3.2 times) the morbidity due to ARIs in organized children's collectives throughout the entire length of the epidemiological period; moreover, it improves the clinical course of ENT organ diseases and bronchial asthma.

A "medical mission" at home: the needs of rural America in terms of otolaryngology care.

OBJECTIVES: Describe the population, Medicaid, uninsured, and otolaryngology practice demographics for 7 representative rural Southeastern states, and propose academic-affiliated outreach clinics as a service to help meet the specialty care needs of an underserved rural population, based on the "medical mission" model employed in international outreach clinics. METHODS: A needs assessment was conducted via review of medical licensing and practice location data from state medical licensing authorities, together with population, Medicaid, and uninsured data from state health/human services departments and the US Census Bureau. RESULTS: In all states examined, there are significantly more practicing otolaryngologists per capita in urban areas compared to rural areas (P < .05), with the exception of West Virginia, where the difference was not statistically significant (P= .33). In the majority of the states examined, there were higher rates (expressed as a percentage of total county population) of both Medicaid recipients and uninsured patients in rural counties compared to urban counties. Notable exceptions include Louisiana and West Virginia, where there are higher percentages of Medicaid patients in urban areas, and Kentucky and Tennessee, where there are higher percentages of uninsured patients in the urban areas (P < .05 for each comparison). CONCLUSIONS: Borrowing design elements from the international outreach clinics, which involve many US otolaryngologists, a similar medical mission model could be of benefit domestically. There are rural areas of the Southeast where visiting outreach clinics could improve access to otolaryngology care and facilitate effective use of existing "safety net" health care resources.

[The importance of studying ENT organs in premature infants].

Otorhinolaryngological examination makes it possible to objectively evaluate the state of ENT organs in prematurely born babies, take adequate measures to ensure their survival, undertake early prevention of ENT pathologies, carry out rehabilitation in case of post-resuscitation or congenital complications, and form groups of children selected for the follow-up and further treatment by an otorhinolaryngologist.

[Mutant prevention concentrations of garenoxacin against Streptococcus pneumoniae isolates from otorhinolaryngological infections].

The minimum inhibitory concentrations (MICs) and the mutant prevention concentrations (MPCs) of garenoxacin (GRNX), were compared to those of levofloxacin (LVFX), and moxifloxacin (MFLX) against 78 Streptococcus pneumoniae isolates from otorhinolaryngological infections in Japan during the period January 2007 to June 2007. The MIC and MPC for 90% of the isolates (MIC90 and MPC90) of GRNX were 0.06 and 0.12 microg/mL, respectively, and were the lower values than LVFX and MFLX MIC90s and MPC90s. The ratios of MPC/MIC of GRNX were the lower values than those of LVFX and MFLX.

Ear, nose, and throat effects of high altitude.

High altitude changes human physiology and can result in illnesses such as acute mountain sickness, high-altitude cerebral edema, and high-altitude pulmonary edema. The physiological impacts of high-altitude illnesses occur secondary to extravasation of fluid from the intravascular space into the extravascular space during a rapid ascent. Headache, hearing disturbances, vestibular disturbances, epistaxis, sleep apnea, coughing, respiratory tract infections, and nasal obstruction are main ear, nose, and throat complaints of individuals travelling to high altitude. These complaints can cause delays or cancelations in a person's climbing plans. In this article, we review the ear, nose, and throat effects of high altitude based on the relevant literature.

[Prophylactic medical examination of military personnel with ENT-diseases].

One of the most important goals in military otolaryngology is a prevention ENT-diseases of armed forces personnel. Prophylactic medical examination of their staff is the major instrument in it. The article presents detailed project of its realization in accordance with present-day classification of ENT-diseases (International Classification of Diseases by World Health Organization), new structure of medical service and its resources and conditions. The diseases of the nose, ear and throat were considered. Algorithm of patients' observation and volume of diagnostic examinations were given.

[Topical problems of occupational pathology of ENT organs].

This paper presents data on the prevalence of occupational diseases of ENT organs dominated by occupational neurosensory deafness (NSD). The prevalence of occupational NSD is highest among the personnel of civilian aviation and the workers employed in mining ore industry. The author emphasizes the utmost importance of timely and high-accuracy diagnostics of ENT organ pathology during prophylactic medical examinations of people exposed to occupational hazards. Information on the state of upper respiratory tracts affected by industrial aerosols that cause irritation and allergic reactions is considered. Special attention is given to the development of methods for diagnosis of occupational oncological diseases and voice disturbances in the voice-and-speech profession.