Clinical otolaryngology and allied sciences
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Clin Otolaryngol Allied Sci · Jun 2003
The effect of combined spinal-epidural (CSE) anaesthesia and size of spinal needle on postoperative hearing loss after elective caesarean section.
The exact aetiology of vestibulocochlear dysfunction after spinal anaesthesia is unknown. Low-frequency hearing loss occurs after spinal anaesthesia. The aim of this study was to investigate the effects of combined spinal-epidural (CSE) anaesthesia and size of spinal needle on vestibulocochlear dysfunction, using pure tone audiometry performed pre- and on the first and the second day postoperatively. ⋯ When 22 G spinal group and 25 G spinal group were compared for change in hearing between the pre- and postoperative periods, there was some hearing loss at low frequency, although this difference did not reach statistical significance. The positive correlation of low-frequency hearing loss and increased pressure in the epidural space (which decrease the risk of cerebrospinal fluid leakage through the dura) suggests that cerebrospinal fluid leakage via the spinal puncture hole is not the only factor involved. Perioperative fluid replacement alone may not prevent hearing loss but CSF loss through the dural puncture site should also be prevented.
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Clin Otolaryngol Allied Sci · Dec 2002
Randomized Controlled Trial Clinical TrialThe use of topical nasal anaesthesia before flexible nasendoscopy: a double-blind, randomized controlled trial comparing cophenylcaine with placebo.
The objective was to evaluate the necessity to use topical nasal anaesthesia before flexible nasendoscopy and to compare its use with placebo. The study was carried out using a double-blind randomized controlled trial, with three treatment arms, at the out-patient department at Raigmore Hospital, Inverness. The participants were 90 patients attending the otolaryngology out-patient department who required flexible nasendoscopy as part of their assessment. ⋯ Overall unpleasantness scores were 2.0 for cophenylcaine, 1.9 for no spray and 2.4 for placebo. On a visual analogue scale of 0-10, none of these mean main outcome measures reached levels of significance. It was concluded that the use of cophenylcaine spray before flexible nasendoscopy does not give significant advantages over the use of no nasal preparation.
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Clin Otolaryngol Allied Sci · Oct 2002
Randomized Controlled Trial Clinical TrialDexamethasone reduces pain after tonsillectomy in adults.
The aim of this study was to assess the effect of a course of dexamethasone on postoperative pain and morbidity after adult tonsillectomy. We report the results of a double-blind, randomized, placebo-controlled trial of 200 adult patients undergoing elective tonsillectomy. Patients were randomized to three groups: one group received the non-steroidal anti-inflammatory drug piroxicam for 8 days postoperatively, one group received dexamethasone for the same period and the third group received both drugs. ⋯ This difference was statistically significant (P < 0.05) on all days except the day of surgery and the second postoperative day. Patients treated with piroxicam alone had significantly higher analgesic requirements than in either of the other groups. Dexamethasone given in this regime reduces postoperative pain and analgesic requirements after adult tonsillectomy.
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Clin Otolaryngol Allied Sci · Apr 2001
Randomized Controlled Trial Multicenter Study Clinical TrialRisk factors for persistence of bilateral otitis media with effusion.
Otitis media with effusion (OME) is a common, episodic condition in childhood. The subset that has persistent bilateral OME is important to identify so that their management can be targeted. Most guidelines suggest a watchful-waiting period before a decision is made on the appropriateness of surgical intervention. ⋯ In this age group, parental report of duration of OME, history of acute otitis media, parental smoking and pars tensa retractions were not significant factors for persistence. These risk factors in combination can increase the odds ratio of persistence more than sixfold. However, the proportion persisting is insufficient to bypass a period of watchful waiting, except perhaps in extreme combinations which apply to less than 7% of the cohort.
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Clin Otolaryngol Allied Sci · Aug 2000
Spiral computed tomography before and after cricothyroid approximation.
Cricothyroid approximation raises the vocal pitch by simulating the contraction of the cricothyroid muscle with sutures. The aim of this study was to determine the role of spiral computed tomography (CT) in patients scheduled for cricothyroid approximation. Twenty-nine transsexual patients were examined with spiral CT before and after laryngoplastic surgery. ⋯ The vocal pitch elevation was more remarkable in the patient group with greater reduction of the cricothyroid distance. Computed tomography accurately determines the cricothyroid distance before and after surgery and is an ideal method for follow-up purposes, especially when there is a postoperative reversion towards a lower pitch. In addition, CT provides important data as to the most appropriate extent and site of intracordal intervention to be done for a desired pitch elevation.