[Psychosomatic aspects in otorhinolaryngology-historical milestones]

BACKGROUND

This investigation examined the development of psychosomatics in the field of otolaryngology in Germany using the examples of psychogenic deafness and chronic tinnitus by means of literature research. The focus of the study was on the period 1948-2022.

METHODS

A literature search was carried out in the PubMed database from 1948 and antiquarian ENT textbooks were evaluated. The search terms used were "ENT and psychosomatics," "tinnitus," "retraining therapy," "analytical psychology," "behavioral therapy," and "sensory systems."

RESULTS

Psychosomatic phenomena were mentioned in the treatment of nasal diseases and ear ailments in writings of Byzantine and medieval medicine. Even older are references to tinnitus in ancient Egyptian and Indian scripts. From the nineteenth to the mid-twentieth century, psychological abnormalities in ENT symptoms were assigned to the term hysteria. From the middle of the twentieth century, a paradigm shift in the assessment of psychosomatic disorders in otolaryngology became apparent. In the 1950s, a broad psychosomatic discussion was opened in individual lectures and book contributions on mental abnormalities in ENT diseases. With the implementation of the Psychosomatics Working Group of the German Society of Otorhinolaryngology, Head and Neck Surgery, psychosomatics in the field of ENT received the framework for scientific and clinical activity at the turn of the millennium. Psychosomatics is scientifically represented and part of the continuing education regulations for otolaryngology in Germany and at European level. It shows high standards in research, qualification of otolaryngologists, and patient care.

CONCLUSION

As of 2022, psychosomatics in otolaryngology has been steadily developing for over 70 years. The standards achieved are to be further expanded and research on cognition, affectivity, and sensory analogies intensified.

[Management of the ENT consultation during the COVID-19 pandemic alert. Are ENT telephone consultations useful?]

Objective

To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty.

Material and methods

From March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23.

Results

During the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone.

Discussion

The state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone.

Conclusion

The telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients.

Management of the ENT Consultation During the COVID-19 Pandemic Alert. Are ENT Telephone Consultations Useful?

Objective

To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty.

Material and methods

From March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23.

Results

During the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone.

Discussion

The state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone.

Conclusion

The telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients.

Digital teaching with interactive case presentations of ENT diseases - discussion of utilisation and motivation of students

Introduction: Due to the circumstances of the Covid-19 pandemic, the teaching during the block internship at the Department for Otorhinolaryngology was switched to digital learning. Various online courses were created and the utilisation by the students was analyzed. Material & methods: Examination videos, surgical images and videos were created and live lectures were held. In addition, patient cases of common otorhinolaryngological diseases were reconstructed on an interactive platform. A total of 16 cases were offered in weekly rotation. These cases are provided with gap texts, open and selection questions, links and videos and thematically appropriate digression offers. The time-consuming creation was carried out as a HTML 5 learning package with the authoring program Exelearning 2.5. Each case was to be evaluated separately after being worked on by the students. Results: The direct feedback and the evaluation results of the students on the internship and case presentations were consistently positive. However, on average only 50.72% of the registered students took part in the weekly video meetings. In the course of the semester, the willingness to participate decreased. In addition, the willingness to evaluate the patient cases was low. Discussion: With the case presentation tool, concrete patient examples can be well presented, especially when patient contact is not possible (especially in an ENT clinic due to violation of distance and hygienic rules). Even though the evaluations were positive in terms of content, the frequency of utilisation and also the motivation for feedback seems disappointing. This seems to be associated above all with an increasing return to everyday life after the end of the lockdown.

Best practice recommendations: ENT consultations during the COVID-19 pandemic

These best practice recommendations for ENT consultations during the COVID-19 pandemic have been drawn up because ENT examinations and treatments are at risk of contamination by the SARS-Cov-2 virus in certain instances. Thus, ENT specialists are among the professionals who are most exposed to this infection. During the pandemic, insofar as an asymptomatic patient may be infected and contagious, the same precautions must be employed whether the patient is ill with, suspected of having, or without any clinical evidence of COVID-19 infection. According to the scientific data available, the examinations and procedures potentially exposing to projections/aerosolizations of organic material of human origin are considered to be at risk of staff contamination. For ENT examinations and procedures without exposure to such projections/aerosolizations, the professional is advised to a long sleeve clean outfit, a surgical mask and gloves in case of contact with the patient's mucosa. ENT examinations and procedures with exposure to these projections/aerosolizations require the so-called "airborne", "contact", and "droplets" additional precautions: FFP2/N95 respiratory protection device, eye protection, disposable headwear and long sleeve overgown.

The Utility and Feasibility of Extending Beyond Traditional Patient Descriptions in Daily Practice

OBJECTIVES/HYPOTHESIS

Institutional and national programs have endorsed the use of validated instruments in daily practice, but their utility for frontline clinicians is unknown. Our first objective was thus to determine if routinely obtained patient descriptions accurately predict disease-specific validated instrument results. Our second objective was to assess the feasibility of deploying an electronic system to obtain and document patient-reported descriptions of health status.

STUDY DESIGN

Prospective assessment of consecutive eligible ambulatory care patients.

METHODS

For the first objective, patients presenting with the same chief complaint at consecutive visits provided concurrent routine symptom descriptions and validated instrument responses. To determine whether patients' routine descriptions predicted scores from disease-specific instruments, receiver operator characteristic (ROC) curves, sensitivity/specificity, Spearman ρ correlation, and regression models were utilized. For the second objective, feasibility assessment focused on percent with successful response capture, time to questionnaire completion, and impact on physician time needed to obtain and document patient histories.

RESULTS

For the first objective, among patients with hearing loss, eustachian tube dysfunction, nasal obstruction, and chronic rhinosinusitis, the areas under the ROC curves were 0.38 to 0.83. Spearman ρ coefficients were 0.25 to 0.46. Sensitivity and specificity ranged from 15.9% to 87.8%, with correct classification in 42.3% to 55.2% of cases. For the second objective, there was a 91% completion rate. Completion times were 7:18 to 12:37 for new patients and 3:23 to 6:41 for established patients. Physician time savings were estimated at 11 minutes per patient.

CONCLUSIONS

Using validated instruments and electronic data collection systems in daily practice has practical and clinical implications. These topics warrant further study.

LEVEL OF EVIDENCE

2c Laryngoscope, 130:S1-S13, 2020.

Comparison of Referral Pathways in Otolaryngology at a Public Versus Private Academic Center

OBJECTIVE

Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC).

METHODS

Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period.

RESULTS

PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities.

CONCLUSIONS

Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care.

LEVEL OF EVIDENCE

2c.

[Blocked Nose, Nosebleeds, Ringing in the Ear: ENT Diseases During Pregnancy]

Blocked Nose, Nosebleeds, Ringing in the Ear: ENT Diseases During Pregnancy Abstract. In this overview the clinical pictures of ear, nose and throat diseases and their symptoms, which occur frequently but also particularly during pregnancy, are presented. In addition, the respective therapy options in this partially vulnerable phase of mother and child are discussed. The primary principle is 'as much as necessary, but as little as possible'. Even if the complaints often disappear with the birth of the child, there may be considerable suffering of the pregnant woman and therapy may be necessary. Moreover, an adequate therapy should be applied with all ENT diseases, even for those not specifically associated with pregnancy.

Evaluation of Ear, Nose, and Throat Involvement in Pemphigus Vulgaris in Comparison with Pemphigus Severity Scoring Systems: A Cross-sectional Study

Pemphigus vulgaris (PV) frequently affects the mucous membranes of the ear, nose, and throat (ENT). Since ENT examination is not a routinely performed procedure, the exact involvement of PV remains unrecognized. The available severity scoring systems (Pemphigus Disease Area Index (PDAI) and Autoimmune Bullous Skin Disorder Intensity Score (ABSIS)) for PV do not include a full ENT examination. This study was designed to evaluate the real extent of PV in ENT areas and to find out the specific scores which indicate the need for ENT examination. The patients were evaluated for ENT manifestations by endoscopic examination whether or not they exhibited symptoms. PDAI, ABSIS, and ENT scores were calculated, and the results were compared for correlation and significance. The mucosal involvement was more severe when scored by ENT examination than when assessed by PDAI or ABSIS. The ENT score was significantly associated with symptoms and endoscopic findings, especially when PDAI ≥15 and/or ABSIS ≥17. ENT endoscopic examination could result in more accurate grading in PV. In particular, performing such an examination should be considered in patients, especially when PDAI ≥15 and/or ABSIS ≥17, regardless of ENT symptoms.

ENT and mucopolysaccharidoses

The mucopolysaccharidoses (MPS) are a heterogeneous group of inherited metabolic disorders, each associated with a deficiency in one of the enzymes involved in glycosaminoglycan (GAG) catabolism. Over time, GAGs accumulate in cells and tissues causing progressive damage, a variety of multi-organ clinical manifestations, and premature death. Ear, nose, and throat (ENT) disorders affect more than 90% of MPS patients and appear in the early stage of MPS; also reported are recurrent otitis media and persistent otitis media with effusion, macroglossia, adenotonsillar hypertrophy, nasal obstruction, obstructive sleep apnoea syndrome (OSAS), hearing loss, and progressive respiratory disorders. Undiagnosed MPS patients are frequently referred to otolaryngologists before the diagnosis of MPS is confirmed. Otolaryngologists thus have an early opportunity to recognize MPS and they can play an increasingly integral role in the multidisciplinary approach to the diagnosis and management of many children with MPS. The ENT commitment is therefore to suspect MPS when non-specific ENT pathologies are associated with repeated surgical treatments, unexplainable worsening of diseases despite correct treatment, and with signs, symptoms, and pathological conditions such as hepatomegaly, inguinal hernia, macrocephaly, macroglossia, coarse facial features, hydrocephalous, joint stiffness, bone deformities, valvular cardiomyopathy, carpal tunnel syndrome, and posture and visual disorders.

Emerging and re-emerging infectious disease in otorhinolaryngology

SUMMARY

Emerging and re-emerging infectious disease in otorhinolaryngology (ENT) are an area of growing epidemiological and clinical interest. The aim of this section is to comprehensively report on the epidemiology of key infectious disease in otorhinolaryngology, reporting on their burden at the national and international level, expanding of the need of promoting and implementing preventive interventions, and the rationale of applying evidence-based, effective and cost- effective diagnostic, curative and preventive approaches. In particular, we focus on i) ENT viral infections (HIV, Epstein-Barr virus, Human Papilloma virus), retrieving the available evidence on their oncogenic potential; ii) typical and atypical mycobacteria infections; iii) non-specific granulomatous lymphadenopathy; iv) emerging paediatric ENT infectious diseases and the prevention of their complications; v) the growing burden of antimicrobial resistance in ENT and the strategies for its control in different clinical settings. We conclude by outlining knowledge gaps and action needed in ENT infectious diseases research and clinical practice and we make references to economic analysis in the field of ENT infectious diseases prevention and care.

[The peculiarities of the clinical picture and treatment of inflammatory ENT diseases in the frequently ill children]

The objective of the present study was the analysis of the current state of the problem of the frequently ill children. The authors present the classification of the frequently ill children together with information concerning the influence of various factors on the incidence of pediatric pathologies with special reference to the major pathogenic agents responsible for the formation of the areas of chronic inflammation in the ENT organs of the children. The approaches to the treatment and rehabilitation of the patients belonging to this age group requiring the follow-up monitoring are considered. It is concluded that the comprehensive strategy is needed for providing the adequate care to such children including specific preventive vaccination, well-timed adequate treatment of acute respiratory conditions, rehabilitative therapy with the use of the adaptogenic substances, the development of resistance to the cold and other unfavourable factors, implementation of the relevant socio-medical programs.

Malnutrition and poor oral health status are major risks among primary school children at Lasbela, Balochistan, Pakistan

BACKGROUND

This survey was focusing on health and oral hygiene status of primary school children at Lasbela district considering the comparatively less developed and socio demographically deprived part of the Country.

METHODS

A cross sectional survey was conducted to determine the health status of primary school children in seven tehseels of district Lasbela, Balochistan after applying proportionate sampling technique from March 2015 to July 2015. Field teams visited assigned schools to screen children and collect health related data on predesigned and pre coded proforma.

RESULTS

Out of 200 schools, 196 schools found opened, while 2% of schools (04) remained closed. A total of 6363 students were clinically screened. About 45% of the school children had normal body mass index (BMI) and rest were falling in different categories of malnutrition. More than 19% had ear, nose and throat (ENT) problems and around 19% presented with clinical anemia. Less than 50% of children had scar of BCG vaccination and 4% informed about use of gutka/supari chewing (smokeless tobacco use).

CONCLUSION

In conclusion, we estimated high prevalence of malnutrition, poor oral health including smokeless tobacco use, and low BCG coverage among primary school children at Lasbela. Current scenario suggests immediate and contextually focused interventions to confine existing public health risks and avoid future burden of disease.

Ear, Nose, Throat and Craniofacial Diseases Community Services Initiative of Khon Kaen University

The Department of Otorhinolaryngology, Faculty of Medicine, Khon Kaen University has cooperated with the local community to establish the welfare and health education service in the local community. The first initiative was carried out in the local primary school. This paper described the missions, method and results of our first attempt to screen the students in the community.

[A Survey of the Otorhinolaryngological Screening of Children in Niigata Prefecture: Kindergarten to High School]

We conducted the first survey of otorhinolaryngological (ORL) screening at educational institutions, from kindergarten to high school, in Niigata Prefecture. The survey results showed that ORL screening is not performed in 62.1% of kindergartens and nursery schools, and that screening was conducted by non-ENT doctors in 23.9% of them. At elementary school entry health check-ups, ORL screening was performed by otorhinolaryngologists in only 4.2% of children overall. ORL screening was conducted in students in all grades by 51.7% of all elementary schools and 31.6% of all junior high schools. Audiometry was performed in students in all grades by over 80% of elementary schools and junior high schools. With regard to high schools, ORL screening was performed in students in all grades at only three schools among 105 high school; ORL screening and audiometry were conducted primarily in the first-year students. In addition to the above results, the survey revealed that no ORL screening whatsoever was performed during a period of 9 years at an elementary school and a junior high school in a certain municipality; as a result of discussion with the relevant municipality, it was decided that screening will be conducted starting at 2016. From the viewpoint of reinforcing the structure of conducting ORL screening in infants in whom ORL findings are identified at a high frequency, we requested that Niigata City conduct ORL screening at private kindergartens in Niigata City where the ORL screening rate is low. We consider this survey to have been productive, as it identified meaningful new facts and measures that could be devised to address the relevant issues. It is our aim to become more proactively than ever involved in school health including health check-ups.

Teleotolaryngology: A Retrospective Review at a Military Tertiary Treatment Facility

OBJECTIVE/HYPOTHESIS: The use of real-time tele-medicine in providing quality health-care in multiple specialties has been demonstrated in several small studies; however, a review of the literature reveals no large-scale prospective or retrospective telemedicine studies in otolaryngology. The tele-medicine office at Naval Medical Center San Diego (NMCSD) acquired a large otolaryngology tele-medicine patient database, and this study reviews the otolaryngology telemedicine experience at NMCSD over an 18-month period.

STUDY DESIGN: We conducted a retrospective and reviewed new patient consults for the NMCSD otolaryngology telemedicine clinic from April 1, 2001, until November 6, 2002.

RESULTS: During the study period, a total of 883 patients received new patient evaluations. Of 883 patients, 568 (64.3%) received a preliminary diagnosis and were treated accordingly. Telemedicine resulted in the avoidance of 22.7% consults. Only 115 (13.0%) of 883 patients required traditional face-to-face otolaryngology consultation. In addition, only 30 (4.3%) of 705 patients who underwent flexible nasopharyngoscopy, otomicroscopy, or nasal endoscopy received incomplete examinations.

CONCLUSIONS: Our study demonstrates the ability of telemedicine to function in an general otolaryngology setting.

[The post-streptococcal diseases in the clinical practice]

The authors describe various clinical forms of streptococcal infections, the pathogenetic mechanisms underlying these conditions, and peculiarities of their clinical picture. Also considered are the modern methods employed for laboratory diagnostics of streptococcal infections. The probability of the risk of development of post-streptococcal diseases in the children is evaluated. Measures for the prevention of these conditions are proposed.

Ear, nose and throat and non-acoustic barotrauma

The organs of the ear, nose and throat (ENT) contain air- or gas-filled cavities, which make them sensitive to pressure changes. There is a specific pathophysiology involved when these structures are exposed to non-acoustic press ure changes, which are usually not traumatic in normals. The concepts of pathophysiology, diagnosis and treatment of these traumas in an emergency setting are reviewed.

[The use of propolis-based therapy in otorhionolaryngology]

The authors analyze the literature publications and the results of their original investigations concerning the application of the propolis-based pharmacological products for the treatment of acute and chronic diseases of the upper respiratory tract and ears. The desirability of the more extensive application of the propolis-containing medicines in the routine otorhinolaryngological practice is emphasized bearing in mind their numerous biological effects including antibiotic, anti-inflammatory, immunostimulating, anti-oxidative, anesthetic, and cytostatic actions.

Manifestation of eosinophilic granulomatosis with polyangiitis in head and neck

INTRODUCTION

Besides an obvious clinical involvement of the ear, nose and throat (ENT)-region in Eosinophilic Granulomatosis with Polyangiitis (EGPA), systematic data is sparse. Only a few case series and case reports are available that particularly describe rhinological, otological or other manifestations of EGPA in the ENT-region. Therefore, the objective of this study is to systematically describe data on ENT-region involvement in a large series of EGPA patients.

METHOD

EGPA patients examined in the Department of Otorhinolaryngology of the Christian-Albrechts-University of Kiel between 1990 and 2010 were included in the study. Criteria for ENT-manifestation were assigned to five subgroups (history, ENT examination, audiological and rhinological diagnostic findings and cranial MRI) and documented cumulatively. EGPA patients were examined in a standardized way based on the validated Ear Nose and Throat Activity Score (ENTAS) or its precursor, including audiological and rhinological diagnostic findings. MRI scans were analysed to further evaluate ENT involvement.

RESULTS

A total of 95 EGPA patients were included in the study. In approximately 80% of them, ENT-involvement was documented and the assumption of a frequent rhinological manifestation in patients with EGPA was confirmed. Moreover, the data reveals remarkable evidence for an otological manifestation. A missing correlation between the rhinological and the otological manifestation indicates an independent autoimmune-inflammatory process for this manifestation.

CONCLUSION

The data of the largest monocentric study presented here confirms the hypothesis of a frequent ENT involvement in EGPA patients, in whom rhinological and otological manifestations are most common. Therefore, treatment should include long term follow-up and should be managed interdisciplinary.

Otolaryngologic manifestations of Noonan syndrome

Noonan syndrome is an autosomal dominant disorder with associated anomalies that include short stature, congenital heart defects, developmental delay, and characteristic facial features among other abnormalities. Articulation deficiency and language delay are often present and require speech therapy. Otitis media and hearing loss have been reported to be common in these patients. We performed a retrospective chart review of pediatric patients who were diagnosed with Noonan syndrome at our tertiary care center from January 1979 through December 2009. We found 19 such patients. Of these, 8 had received single-specialty care at our hospital; it is not known if they had received otolaryngologic care from an outside provider. These 8 patients were not included in our study. The remaining 11 patients-6 boys and 5 girls, aged 1 to 19 years (mean: 9.2)-had all received multidisciplinary care at our institution; 9 of them had received care from an otolaryngologist at our center. Of this group, 7 had history of feeding difficulty, 6 had experienced speech delay that required speech therapy, 6 had undergone placement of a pressure equalization tube, 4 had undergone adenoidectomy with or without tonsillectomy, and 1 had been treated with endoscopic sinus surgery. Although this study is limited by our small number of patients, our results suggest that early otolaryngologist involvement must be considered in the care of children with Noonan syndrome because many have evidence of eustachian tube dysfunction, hearing loss, and speech delay.

Correlation of Otorhinolaryngologic Symptoms with Physical Findings in Behçet's Disease

OBJECTIVE

Behçet's disease is a chronic systemic inflammatory disease of unknown etiology. We examined the correlation between otorhinolaryngologic symptoms and otorhinolaryngologic physical findings in patients with Behçet's disease, in search of strategies to reduce the morbidity rates.

METHODS

Seventy-two patients diagnosed with Behçet's disease were included. After giving a detailed history of oropharyngeal, nasal, laryngeal, and otic symptoms, patients were examined endoscopically by an otolaryngologist, and the findings were recorded.

RESULTS

Thirty-nine of the patients were male, and thirty-three were female. The mean age was 39.2 ± 3.4, and the mean disease duration was 8.24 ± 4.2 years. Statistically significant correlations were observed between ear lesions and ear symptoms (crusting and otic pain), nasal lesions and nasal symptoms (crusting and nasal pain), oropharyngeal lesions and oropharyngeal symptoms (pain and difficulty in swallowing), and laryngeal lesions and laryngeal symptoms (hoarseness, difficulty in swallowing, and pain).

CONCLUSION

The results demonstrated a positive correlation between symptoms and otorhinolaryngeal examination findings in Behçet's disease. Potential morbidities can be prevented by routine endoscopic otorhinolaryngeal examinations and symptom screening of patients with Behçet's disease and arranging the therapy accordingly.

[ENT localisation of amyloidosis: 20 patients report]

BACKGROUND

Amyloidosis is a rare pathology, due to a toxic accumulation of amyloid proteins infiltrating tissues. Published studies have low statistical power. However it seems that ENT localization have favorable prognosis. Management and check up are not well codified.

METHODS

Bicentric retros­pec­tive study conducted between 1987 and 2015, from patient diagnosed with ENT amyloidosis. The study was performed to the database of the pathology department. People concerned, history, symptoms and diagnostic features were analysed. The immunologic and clinical status, locations, extension check, treatment and prognosis have been evaluated.

RESULTS

Twenty patients were evaluated, ten men and ten women, average age was 55.5 year of age. Three patients were afflicted with familial amyloidosis. Main localisation was larynx (80%), main type was immunoglobulinic (AL) (80%). Amyloidosis was mostly localised (90%) and primary form (80%). Dysphonia was the most frequently encountered symptom. Most performed exami­na­tion were local biopsy and creatinine clearance (100%), serum protein electrophoresis (SEP) (89%), myelogram and/or bone marrow aspiration (75%), and trans thoracic echography (TTE) (75%). Surgical removal was performed for 75% of the patients. Global rate of recurrence was 70%, about 4.6 years after diagnosis. In familial forms, overall survival was 66% at ten years. In non-familial forms, overall survival was 100%.

CONCLUSION

ENT amyloidosis are mostly AL, laryngeal, prima­ry and localised. Distant extension check should be managed by internal medicine specialist and associate creati­ni­ne clea­ran­ce, local biopsy, TTE, SEP and myelogram. Head and neck forms treatment is based on surgical removal, familial forms are of poor prognosis.

[Common infections of the ear, nose, and throat]

Infectious diseases of the ear, nose and throat are common reasons why patients visit their family physician. Therefore, the aim of this mini-review is to give an overview of the most important and frequent infectious diseases of the ear, nose and throat, the appropriate diagnostic measurements and therapy with relevance for the family physician. Most of these infectious diseases can be treated by the family physician and do not necessarily need to be seen by an ENT-specialist.

Expressions and roles of periostin in otolaryngological diseases

Periostin is a 90-kDa member of the fasciclin-containing family; it functions as part of matricellular proteins, and its production by airway epithelial cells is induced by IL-4 and IL-13. Periostin is secreted by fibroblasts and upregulated in the airway epithelia of patients with bronchial asthma; it is considered to contribute to remodeling under this pathological condition. However, despite many studies in diverse research areas, our overall understanding of this intriguing molecule is still inadequate. Here, we integrate the available evidence on periostin expression and its roles in otolaryngological diseases, including allergic rhinitis, chronic rhinosinusitis with nasal polyps, aspirin-induced asthma, organized hematoma, eosinophilic otitis media, and IgG4-related disease. Periostin might be involved as an important structural mediator in pathological processes such as insult and injury, Th2-driven inflammation, extracellular matrix restructuring, fibrosclerosis, tumor angiogenesis, and tissue remodeling.

Pediatric otolaryngology in a field hospital in the Philippines

BACKGROUND

Major natural disasters adversely affect local medical services and resources. We sought to characterize pediatric patients presenting with otolaryngology-head and neck surgery (OTO-HNS)-related diseases/injuries to a field hospital over 11 days of operation, which was deployed to assist the healthcare facilities in Bogo, the Philippines, in the aftermath of typhoon Haiyan (Yolanda).

METHODS

We reviewed charts of pediatric patients aged 0-18 years visiting our field hospital, who presented with OTO-HNS-related diseases/injuries. We also describe the structure of the field hospital, equipment, facilities and capabilities of our service, discuss medical and ethical concerns, and propose several recommendations for future similar missions.

RESULTS

Of the 863 pediatric visits, 91 (11%) presented with OTO-HNS-related diseases/injuries, 3 of them were of recurring patients. Of the 88 included individual patients, 47 (53%) were boys, with an average age of 6.9±4.9 years. Ear-related diseases, mostly acute otitis media (AOM), and neck-related diseases were the most common pathologies (49% and 16% of the patients, respectively). Antibiotic therapy was administered to 36 (41%) patients, mostly to children with AOM. Despite limited resources, we were able to perform surgical interventions on 8 (9%) patients, which included laceration suturing, abscess drainage and neck surgery.

CONCLUSIONS

Otolaryngologists have an important role in the treatment of children affected in a disaster area, at a time of an increased demand for healthcare. Unlike 'acute phase' missions, where traumatic injuries are the focus for treatment, 'subacute' phase missions provide more routine medical and surgical care.

Clinical manifestation of pediatric granulomatosis with polyangiitis - the experience of two regions in Poland

BACKGROUND

The purpose of this study was to describe clinical manifestations, laboratory findings and outcome of granulomatosis with polyangiitis (GPA) in pediatric patients living in two regions (Southern and Central) of Poland.

METHODS

Retrospective analysis of patient hospital records from four large hospitals during a period from 1995 to 2013. Patients with confirmed diagnosis of GPA according to American College of Rheumatology (ACR) and EULAR/PRINTO/PRES criteria for GPA were analyzed. All patients were subjected to clinical, laboratory, radiological and immunological assessment.

RESULTS

During this 18-year period only 9 children with confirmed diagnosis of GPA (6 girls, 3 boys) were identified. The average age of the disease onset was 12 years (range: 8-16 years). Average delay between first symptoms and diagnosis was approx. 20 months (range: 0-84 months). Organ system involvement at presentation included: kidneys 88.8% (8/9), lungs 77.7% (7/9), ear/nose/ throat 55.5% (5/9), gastrointestinal tract 55.5% (5/9), skin 44.4% (4/9), joints 22.2% (2/9), eyes 11.1% (1/9) and nervous system 11.1% (1/9). In 5 children disease course was progressive (constant progression of sinusitis in one case, end-stage renal disease in two, chronic kidney disease stage IV in one and one child died due to alveolar hemorrhage).

CONCLUSION

The majority of our patients were females. Clinical features of pediatric GPA were similar to those described in adults. None of our patients developed subglottic stenosis and in only 2 children saddle-nose deformity was observed. Although GPA was treated according to contemporary standards care, disease progression was observed in more than a half of children.

[Otorhinolaryngology]

Once more, this selection of papers is intended towards the general practionner, avoiding deliberately technical papers. Last year, we focused on rhinology and head and neck surgery, and this year we choose other themes, like dysphonia, gastroesophagal reflux, robotic surgery or interest of PET in thyroid screening. Several meta-analysis are presented, regarding long term antibiotic treatments in case of chronic otitis media, tonsillotomy versus tonsillectomy, MRSA prevalence, or sudden hearing loss.

[Chronic tonsillitis in the students of a humanitarian higher school: incidence, diagnostics, and therapeutic strategies]

The objective of the present work was to study peculiar features of the nosological structure of chronic ENT pathology in the applicants and students of a higher education institution and perform a thorough analysis of the prevalence of various forms of chronic pharyngeal diseases. The study was based at the Polyclinic of Moscow State Institute of International Relations, Russian Ministry of Foreign Affairs, and lasted from 1998 to 2011. A total of 42 829 subjects aged between 15-30 years were examined including 32 186 applicants undergoing physical qualification by the medical evaluation board and 10 643 students subjected to routine annual medical examination. The latter group was characterized by the high prevalence of chronic ENT diseases predominated by pharyngeal pathology (39.6-59.8%). Chronic pharyngeal pathology was prevailed by chronic tonsillitis (32.7-50.6%) followed in the descending order by chronic pharyngitis (16.9-25.2%), papillomas affecting the soft palate, palatine arches and tonsils (0.8-1.5%), and adenoid vegetations (0.05-0.4%). It is concluded that regular medical check-up and treatment provide an effective tool for the prevention of CT progression and the development of its complications in the young subjects. 93.81% of the students were removed from dispensary observation due to improvement of health conditions or recovery. It is concluded that the surgical treatment of CT (bilateral tonsillectomy) should be more extensively applied in the absence of the desired effect of its conservative therapy.

[Epidemiology of paediatric emergencies in ENT]

OBJECTIVE

To assess the prevalence and severity of pediatric emergencies in ENT in Casablanca.

MATERIAL AND METHODS

This is a retrospective study over two years from January 1st 2010 to December 31, 2011, covering 2220 pediatric othorhinolaryngology emergencies observed in the emergency department of the "20 August Casablanca" hospital.

RESULTS

Males predominate and account for 72.25% compared to 27.74% of girls. The mean age was 7.5 years ranging from 03 months to 15 years. Five pathologies top the list; head and neck wounds (28.11%), foreign bodies (21.62%), infectious emergencies (21.57%), blunt trauma (16.39%), and finally hemorrhages from natural orifices (11.22%).

CONCLUSION

This study assessed the prevalence and severity of ENT emergencies in children in Casablanca.

[Diagnostics of sepsis in the patients presenting with pyo-inflammatory ENT pathology]

The objective of the present study was to develop the algorithm for early clinical, laboratory, and instrumental diagnostics of sepsis in the patients presenting with pyo-inflammatory ENT diseases. The study included 50 patients with pyo-inflammatory ENT diseases complicated by generalization of infection. The scheme (algorithm) developed for their examination allowed to diagnose sepsis at the early stages of hospitalization in the patients presenting with pyo-inflammatory ENT pathology. The diagnostic algorithm included the criteria for syndrome of systemic inflammatory reaction (SSIR), the Kalf-Kalif leukocytic intoxication index (LII), the procalcitonin test (PKT), the integral severity of illness scale (APACHE-II) and the organ failure assessment score (SOFA). Timely preoperative diagnostics of septic complications and sanation of the primary infection site in the combination with early intensive therapy under conditions of a resuscitation department made it possible to avoid further progress of generalization of the infection and thereby to reduce the number of secondary interventions, to improve prognosis of the disease, and lower the mortality rate down to 12% in the study group (compared with 44% in the control one).

Diagnostic dilemma of primary mucosal leishmaniasis

Leishmaniasis is caused by Leishmania protozoa. It is widely present in more than 88 countries worldwide, resulting in up to 80,000 deaths annually. Leishmaniasis occurs as visceral, cutaneous, or mucocutaneous variants. Mucosal involvement can occur secondarily to the cutaneous or visceral varieties. However, primary mucosal leishmaniasis (PML) occurs without any present or past cutaneous and or visceral disease. It is extremely rare, and its diagnosis may present a serious challenge. It may be difficult to differentiate it from granulomatous conditions like tuberculosis, sarcoidosis, leprosy, fungal infections, Wegener's granuloma, and neoplasms. Here, we present a case of PML in Saudi Arabia.

Sample of a client intake information protocol: a synopsis and rationale

The utilization of standardized comprehensive forms in the field of orofacial myology is crucial as this profession continues to grow and establish assessment and treatment protocols. This article formally presents a comprehensive health history intake form currently in use, and highlights the rationale for each particular question within this form in an effort to explore the evidence-based theory behind each question utilized. Highlighting the importance of obtaining a thorough health history as it pertains to our profession, personally allows the clinician to ultimately best plan a therapeutic strategy and assess the individual criteria necessary for successful orofacial myofunctional habituation.