Otorhinolaryngological problems occurring within the intensive care unit

Eustachian tube dysfunction leading to middle-ear pathology in patients on chronic mechanical ventilation

OBJECTIVE

This study aimed to investigate the prevalence of and risk factors for Eustachian tube dysfunction leading to middle-ear pathology in patients on chronic mechanical ventilation via tracheostomy tube.

METHODS

A total of 40 patients on chronic ventilation were included in a prospective cohort study. Middle-ear status was determined by tympanometry. Tympanograms were categorised as types A, B or C; types B and C were defined as middle-ear pathology.

RESULTS

In all, 57 ears of 40 patients were examined. Disease was found in at least 1 ear in 26 out of 40 patients. Middle-ear pathology was found in 25 out of 34 patients who were tube fed (via nasogastric tube or percutaneous endoscopic gastrostomy) vs 1 patient out of the 6 fed orally (p = 0.014), and in 23 out of 31 with conscious or cognitive impairment vs 3 out of 9 cognitively intact patients (p = 0.044).

CONCLUSION

Middle-ear pathology is common in patients on chronic mechanical ventilation via tracheostomy tube. The highest prevalence was in those with impaired consciousness or cognition, and oral feeding appeared protective.

Safety of sphenoid aspiration for diagnosis and treatment of intensive care unit rhinosinusitis

BACKGROUND

In intensive care units (ICUs), critically ill patients may be exposed to several risk factors for developing acute rhinosinusitis, including nasogastric tubes, mechanical ventilation, and prolonged periods in the supine position. The incidence of acute rhinosinusitis can be as high as 83%, the third or fourth most frequent ICU infection and it increases the risk of developing ventilator-associated pneumonia. Diagnosis and therapeutic approaches should be more aggressive than in non-ICU patients. Antral puncture plays a central role in the diagnosis and treatment of these patients. This study was designed to show the development of a method for sphenoid puncture in the diagnosis and treatment of acute infectious rhinosinusitis in critically ill patients, analyzing safety and complications.

METHODS

Patients in ICUs with endoscopic and radiological diagnosis of acute rhinosinusitis were included. Maxillary puncture was performed through the inferior meatus; sphenoid puncture was performed by endoscopic identification of the sphenoethmoidal recess. An aspiration probe was introduced into the natural sphenoidal ostium, followed by aspiration of secretions and saline irrigation.

RESULTS

Twenty-nine patients were included. Twenty-seven patients (93.1%) presented with sphenoidal sinusitis, 24 patients (82.7%) had maxillary sinusitis, 21 patients (72.4%) had ethmoidal sinusitis, and 13 patients (44.8%) had frontal sinusitis. Forty-seven sphenoidal and 39 maxillary punctures were performed. No major bleeding or other complications were recorded.

CONCLUSION

The sphenoid puncture is a possible procedure to be performed in an ICU and might complement the paranasal puncture in cases of acute rhinosinusitis.