European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery
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Eur Arch Otorhinolaryngol · Jun 2009
Randomized Controlled Trial Multicenter StudyAdditional use of acupuncture to NSAID effectively reduces post-tonsillectomy pain.
Post-tonsillectomy swallowing pain is a common and distressing side effect after tonsillectomy and thus of great clinical interest. Up until now, there is no randomized controlled patient- and observer-blinded study evaluating the efficacy of acupuncture against swallowing pain after tonsillectomy. We therefore compared the potency of specific verum acupuncture points related to a Chinese medical diagnosis in reducing postoperative swallowing pain with non-specific control points on the body as well as a non-acupuncture group who received standard medication only. ⋯ In comparison to the acupuncture, they also reported an average of 3 h duration of adequate pain-relief past taking the NSAID. This trial strongly supports a specific acupuncture scheme for the treatment of postoperative swallowing pain after tonsillectomy. It may particularly serve as an alternative pain treatment in case of NSAID intolerances.
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Eur Arch Otorhinolaryngol · Jun 2009
Comparative StudySpiral CT virtual bronchoscopy with multiplanar reformatting in the evaluation of post-intubation tracheal stenosis: comparison between endoscopic, radiological and surgical findings.
We evaluated the usefulness and accuracy of spiral CT in detection and assessment of post-intubation tracheal stenosis. Fourteen patients with post intubation stenosis underwent evaluation of their airway by spiral CT scan with multiplanar reformatting (MPR) and virtual endoscopy (VE) and conventional rigid bronchoscopy, and telescopy (RB). The following parameters were assessed: involvement of the subglottic larynx, site, number, and degree of the stenosis. ⋯ CT measurements correctly estimated 15/16 (93.75%) lesions and allowed accurate measurements of the stenotic segment as well as the proximal and distal airway segments. Spiral CT scan with MPR and VE may be considered as a substitute to direct endoscopic examination and the additional information on laryngeal function can be easily obtained during flexible nasolaryngoscopic examination of the awake patient. This policy can minimize patient morbidity and spare them an extra anaesthetic for evaluation.
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Eur Arch Otorhinolaryngol · Jun 2009
Long-term results with a simple technique of stoma creation after laryngectomy.
Stomal stenosis after laryngectomy has a major impact on patient rehabilitation. The major contributory factor is the operative technique. The goal is to achieve a widely patent stoma. ⋯ Amongst these patients with narrow stoma, only 1 patient (1.7%) has had dilatation done and the others are managing reasonably with a stoma button. None of the patients in this study has required revision procedures on the stoma. The simple technique of stoma creation described in this study has good long-term results.
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Eur Arch Otorhinolaryngol · May 2009
Case ReportsA simple method to alleviate aspiration in the near-total laryngectomy patient.
Near-total laryngectomy is a surgical technique which grants the potential for postoperative speech without the need for prostheses or secondary surgical procedures. Aspiration can be a problem, however, that can require completion laryngectomy to resolve. A 60-year-old male underwent a near-total laryngectomy for recurrent laryngeal cancer. ⋯ At approximately 17 months, the patient developed recurrent intermittent aspiration of thin liquids and required reinjection of the shunt, with resolution of the aspiration. Calcium hydroxylapatite allows simple and effective alleviation of aspiration following near-total laryngectomy but requires repeated injection to maintain efficacy. Injection of calcium hydroxylapatite can be an effective alternative to completion laryngectomy in patients who aspirate following near-total laryngectomy.
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Eur Arch Otorhinolaryngol · May 2009
Preoperative clinical prediction of difficult laryngeal exposure in suspension laryngoscopy.
We investigated general and physical predictors of difficult laryngeal exposure in patients undergoing suspension laryngoscopy; 93 patients were included in this prospective study. The patients were classified as difficult laryngeal exposure group or non-difficult laryngeal exposure group based on the laryngeal view in suspension laryngoscopy. Twelve parameters (age, sex, body mass index, neck circumference, full mouth opening, modified mallampati index, hyoid-mental, thyroid-mental, horizontal thyroid-mental, vertical thyroid-mental, sternum-mental distance) that could predict difficult laryngeal exposure were evaluated. ⋯ Based on the multivariate analysis, neck circumference superior to 40 cm, hyoid-mental and sternum-mental distance with respectively a value less than 6.05 and 13.9 cm were independently associated with difficult laryngeal exposure. Muscular neck, hyoid-mental and sterno-mental distance should be considered clinical predictors of difficult laryngeal exposure. Measurements of physical variables at full extension position of the neck are more useful and reliable predictors than neutral position for the risk of difficult laryngeal exposure.