Acta oto-laryngologica
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Acta oto-laryngologica · May 2008
Comparative Study Clinical TrialLong-term prophylactic treatment of attacks of vertigo in Menière's disease--comparison of a high with a low dosage of betahistine in an open trial.
Despite the considerable limitations of an open, non-masked trial, particularly in Menière's disease (MD), a higher dosage of betahistine-dihydrochloride and a long-term treatment seems to be more effective than a low dosage and short-term treatment. ⋯ A total of 112 patients were included in the analysis: 50 received betahistine-dihydrochloride in a low dosage (16 mg tid, n=21, 24 mg, n=29) and 62 received 48 mg tid. Follow-up examination every 3 months showed that the number of attacks per month decreased in both groups over time. For instance, after 12 months the mean (median) number of attacks dropped from 7.6 (4.5) to 4.4 (2.0) (p<0.0001) in the low-dosage group, and from 8.8 (5.5) to 1.0 (0.0) (p<0.0001) in the high dosage group. The number of attacks after 12 months was significantly lower in the high dosage group than in the low dosage group (p(12M)=0.0002). The treatment was well tolerated in both groups.
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Pulsatile tinnitus requires a careful physical examination and evaluation with selected imaging techniques to identify the origin of the symptoms. ⋯ Fifty-four patients were seen between January 2002 and June 2007 with the chief complaint of constant pulsatile tinnitus, excluding those with chemodectomas. On the basis of physical examination and imaging, 14 were considered arterial, 23 venous, and 15 were indeterminate in origin. Among patients with venous tinnitus, sigmoid sinus diverticulum was the most common finding. Among patients with arterial tinnitus, carotid atherosclerotic disease was the most common. One patient had erosion of the cochlea by the carotid artery. Non-vascular entities identified include superior semicircular canal dehiscence and benign intracranial hypertension.
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Acta oto-laryngologica · Feb 2008
Laryngeal fractures: clinical findings and considerations on suboptimal outcome.
We recommend early surgical exploration and fixation for patients with dislocated or comminuted laryngeal fractures to avoid long-term voice complications. One-third of 33 fracture patients rated their voice after the fracture had healed as fair but altered. ⋯ In all, 32 of 33 laryngeal fracture patients had blunt trauma and the main causative factors were sport injuries (39%) and physical assault (33%). All of the 33 laryngeal fracture patients had a good airway outcome. The subjective voice outcome was good for 20 (61%) and fair for 13 (39%) patients. The mean follow-up time was 39.5 months (range 2-114 months). In phoniatric evaluation most (six of eight) patients with fair voice outcome could not produce high pitched voices because of inability to stretch the vocal folds.
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Acta oto-laryngologica · Jan 2008
Comparative StudyTreatment results and prognostic factors in locally advanced hypopharyngeal cancer.
We suggest that concurrent chemoradiation (CCRT) is an effective definitive treatment for patients with advanced hypopharyngeal carcinoma who are unfit for or refuse surgery. A high dose of radiation (> 70 Gy) should be given to achieve acceptable local control rates and survival. ⋯ There was no significant difference in T and N status between the two treatment groups, nor were there significant differences in overall or disease-free survival or the incidence of distant metastasis (p >0.05). In the CCRT group and SRT group, the estimated 3-year overall survival was 39% and 44%, respectively. The SRT group had better local control than the CCRT group (p <0.05). Relatively, 27% patients retained their larynx function for more than 2 years in the CCRT group. Radiation doses >70 Gy yielded significantly better survival and local control than doses <70 Gy (p <0.05).
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Postoperative odynophagia should be assessed by a variety of methods including visual analogue scale (VAS) pain scores (subjective), clinical data (objective qualitative) and surface electromyography (sEMG; objective quantitative). sEMG might be used for quantitative evaluation of odynophagia when aggravation or hysteria-conversion reaction is suspected. Tonsillectomy affects muscle activity significantly by involving additional muscles in deglutition. ⋯ Signs of clinical recovery after tonsillectomy did not always correspond with the VAS pain score evolution. sEMG was more in concord with clinical recovery than VAS. Electric activity of MS and LSM was significantly higher among the patients in comparison with a normative database (p<0.005).