Ann Oto Rhinol Laryn
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Ann Oto Rhinol Laryn · Sep 2000
Meta Analysis Comparative StudyDilatational versus standard tracheostomy: a meta-analysis.
The advent of percutaneous dilatational tracheostomy (PDT) was initially viewed by otolaryngologists with great skepticism. The purpose of this study was to compare the complications of PDT with those of standard tracheostomy (ST) by a meta-analysis of randomized studies. We found that ST had a fivefold higher rate of complications than did PDT, and these complications were often more severe. We conclude that PDT is a safer procedure for elective tracheostomy in carefully selected patients, ie, those with normal-sized necks.
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Ann Oto Rhinol Laryn · Jun 2000
Idiopathic sudden sensorineural hearing loss: temporal bone histopathologic study.
We microscopically examined the temporal bones of 12 ears with idiopathic sudden sensorineural hearing loss (iSSNHL), 10 ears with presbycusis, 11 ears with normal hearing, and 8 unaffected contralateral ears of patients with iSSNHL. The degeneration of the spiral ligament, vascular stria, hair cells, dendrites, and apical spiral ganglion cells was greater in ears with iSSNHL than in the other groups. ⋯ Cochlear ossification was found in 1 ear with iSSNHL, and hydrops in 2. These findings suggest a viral rather than a vascular or ruptured inner ear membrane origin for iSSNHL.
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Ann Oto Rhinol Laryn · Dec 1999
Comparative StudyMaturation of the pediatric tracheostomy stoma: effect on complications.
The pediatric tracheostomy stoma can be matured via a technique that places 4-quadrant sutures from the tracheal cartilage to the dermis. This has the potential of decreasing the risk of accidental decannulation and the formation of granulation tissue. A retrospective analysis of 149 tracheostomies performed between January 1989 and December 1996 was done for the following factors: age, underlying diagnosis, indication for tracheostomy, type of tracheal incision, maturation of stoma, duration of tracheostomy, and early and late (>7 days) complications. ⋯ Granulation tissue was found on subsequent laryngoscopy in 24 (27.3%) of the 88 matured stomas versus 23 (37.7%) of the 61 nonmatured stomas. There were no tracheostomy-related mortalities. Maturing the tracheostomy stoma resulted in a decreased morbidity from accidental decannulations and did not increase the incidence of tracheocutaneous fistulas or granulation tissue formation.
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Ann Oto Rhinol Laryn · Aug 1999
Review Comparative Study Historical ArticleAnalysis of the forces and position required for direct laryngoscopic exposure of the anterior vocal folds.
The sniffing position is traditionally considered optimal for direct laryngoscopic examination of the vocal folds. This study examined head and neck positions associated with ideal exposure of the anterior glottal commissure with a variety of laryngoscopes. A prospective investigation was done in 20 patients by comparing the force required to expose the anterior vocal folds by utilizing 3 head and neck positions with 3 different-sized tubular laryngoscopes. ⋯ Because this places the laryngoscope lumen in a vertical position, this position is inappropriate for microlaryngoscopy. The study reinforced the concept that the sniffing position is the optimal position for microlaryngoscopy because it enables the use of the largest-lumened laryngoscope. This facilitates ideal exposure of the anterior vocal folds, which is necessary for phonomicrosurgery.
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This study was undertaken to determine whether smokers have a higher risk of complications after reconstruction of facial skin defects. Ninety-one patients with facial skin defects reconstructed with local flaps were reviewed retrospectively. Thirty-eight (42%) were active smokers, 12 (13%) had not smoked for at least 1 year prior to surgery, and the rest were nonsmokers. ⋯ All full-thickness skin losses and all cellulitis occurred in active smokers. We conclude that active smokers are at a higher risk for complications in facial skin flap surgery. That ex-smokers had a complication rate similar to that of nonsmokers suggests that part of smoking's adverse effect on skin flaps may be an acute phenomenon, and that smoking cessation for shorter (<1 year) periods of time before surgery may have a beneficial effect.