The Laryngoscope
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Randomized Controlled Trial
Effectiveness of amitriptyline versus cough suppressants in the treatment of chronic cough resulting from postviral vagal neuropathy.
The objective of this prospective, randomized, controlled study (N = 28) was to evaluate the effectiveness of amitriptyline versus cough suppressants in the treatment of chronic cough resulting from postviral vagal neuropathy. ⋯ Chronic cough can have a profound impact on the psychosocial function of patients. The most common causes of a persisting cough in the absence of infection or chronic smoking are laryngopharyngeal reflux, asthma, particularly the cough variant, allergy, rhinosinusitis, bronchitis, and medications, in particular angiotensin-converting enzyme inhibitors. Currently, there are few effective treatments for cough with an acceptable therapeutic ratio and more selective drugs with a more favorable side effect profile are needed. This is this first prospective, randomized, controlled study comparing the effectiveness of amitriptyline versus codeine/guaifenesin for select cases of chronic cough resulting from suspected postviral vagal neuropathy.
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Mumps virus infections primarily involve the parotid glands and most frequently affect school-aged children. We present three unusual adult cases of mumps with dyspnea secondary to severe swelling of the salivary glands and review previously reported cases in the literature. ⋯ In two cases, tracheotomy was needed because of rapid worsening of the supraglottic edema. Questioning regarding breathing problems and laryngoscopic examination is therefore recommended when one encounters a mumps case with combined parotid and salivary gland swelling.
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Comparative Study
Evaluation of culture and antibiotic use in patients with pharyngitis.
The objectives of this study were to evaluate practice patterns for treatment of patients with pharyngitis with regard to testing for group A beta hemolytic streptococcal (GABHS) infection, frequency of antibiotic use, and appropriate choice of antibiotics. ⋯ Most patients seen for pharyngitis were tested for GABHS, but pediatric patients were tested more frequently than adults. Patients who received a GAST were less likely to receive antibiotics. The rates experienced in our tertiary academic institution are higher than previously quoted for community practice. When antibiotics were prescribed, they were usually appropriate for the treatment of GABHS based on current recommendations.
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Comparative Study
Application of magnetic resonance virtual endoscopy as a presurgical procedure before sialoendoscopy.
The objectives of this study were to investigate the feasibility of clinical application of magnetic resonance (MR) virtual endoscopy as a presurgical procedure before sialoendoscopy and to evaluate its value in the diagnosis of obstructive salivary gland diseases and preoperative visualization of endoluminal views. ⋯ MR virtual endoscopy is an effective and noninvasive diagnostic method for evaluating the endoluminal anatomy and pathologies of the salivary duct. The clinical application of MR virtual endoscopy as a presurgical procedure before sialoendoscopy is a valuable and promising approach, which can provide surgeons useful morphologic and pathologic information.
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In patients with large dural defects of the anterior and ventral skull base after endonasal skull base surgery, there is a significant risk of a postoperative cerebrospinal fluid leak after reconstruction. Reconstruction with vascularized tissue is desirable to facilitate rapid healing, especially in irradiated patients. ⋯ The HBF is a versatile and reliable reconstructive technique for defects of the anterior, middle, clival, and parasellar skull base. Its use has resulted in a sharp decrease in the incidence of postoperative cerebrospinal fluid leaks after endonasal skull base surgery and is recommended for the reconstruction of large dural defects and when postoperative radiation therapy is anticipated.