ISSN:0307-7772    

DOI:10.1046/j.1365-2273.1996.00858.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

The hearing improvement obtained by revision surgery for otosclerosis has been assessed in 163 patients with a conductive hearing loss. Several different surgical techniques had been used at the primary operation. On average at revision a hearing improvement of 11 dB was obtained. The hearing improvement was related to the surgical technique of the primary operation, the middle ear abnormalities and the surgical technique used at revision. Patients in whom a small‐fenestra‐technique had been used for the primary as well as the revision procedure, had a better result than patients who had total removal of the footplate. Patients with adhesions and an eccentric prosthesis only showed a small hearing improvement. Patients with necrosis of the long process of the incus were also difficult to manage. Since the complication rate was low it does not seem to be more dangerous to perform a revision than to perform a primary operation. The results obtained by revision are poorer than can be obtained by the primary procedure. This indicates that in stapes surgery the greatest chance for hearing improvement is the first operation, therefore centralization of this type of operation should be conside

ISSN:0307-7772    

DOI:10.1046/j.1365-2273.1996.00792.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Allergic fungal sinusitis is a non‐invasive disease, first described in the early 1980s. We review our experience with 25 patients treated at the University of Texas Medical Branch, Galveston. All patients were treated surgically, using endoscopic techniques in 17, and combined endoscopic and external procedures in eight. Histological evidence of tissue invasion was absent in all 25 patients, in spite of extensive destruction of the skull base in four. Dematiaceous fungi were the most common cultural isolate. Fifteen patients were available for more than 6 months post‐operative follow‐up. None of the eight patients who developed recurrent disease had been treated with post‐operative systemic steroids. Four of the seven patients who remained disease‐free had received steroids. Clinical trials to test the efficacy of systemic steroids in the prevention of disease recurrence are clearly

ISSN:0307-7772    

DOI:10.1046/j.1365-2273.1996.00807.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

During the 17‐year period from 1977 to 1994 a total of 23 patients in Copenhagen County were admitted to hospital with facial palsy, developed during acute otitis media. This corresponds to an annual incidence of 2.3 per million inhabitants. In the pre‐antibiotic era it was estimated that 0.5% of patients with acute otitis media developed facial palsy. Our figures indicate a decrease of this complication by a factor of 100, to 0.005%. Although fourteen of the patients were children, the risk of an acute otitis media being complicated by facial palsy seems to be highest in adults (who have a low incidence of acute otitis media). All the children were ≤3 years of age and 2/3 of the adults ≥50 years of age. Complete remission was seen in all patients, except one. The time interval to complete remission was correlated significantly with the degree of the facial palsy on admission, as it was longest in the most severe facial

ISSN:0307-7772    

DOI:10.1046/j.1365-2273.1996.00810.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Congestion of one side of the nose is accompanied by decongestion of the other side. This is called the nasal cycle. The nasal cycle does not seem to be present in all subjects and it has not been shown with rhinostereometry. There are very few studies showing whether there are spontaneous day‐to‐day variations in nasal mucosal congestion and no studies showing differences in nasal mucosal congestion between morning and afternoon. This, however, may be very important in studies covering a longer period. In the present study, data from four healthy volunteers were recorded 18 or 19 times in the mornings and afternoons on different days. Measurements were made with rhinostereometry, a peak flow meter (PNIF) and by symptom scores. A nasal cycle was found in some subjects. There was no difference in total nasal mucosal swelling in the mornings and in the afternoons and no day‐to‐day variation in the total nasal mucosal s

ISSN:0307-7772    

DOI:10.1046/j.1365-2273.1996.00812.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

Hyperbaric oxygen therapy is associated with a risk of barotrauma to the middle ear. This prospective study of 82 patients undergoing long‐term therapy for chronic conditions was designed to measure the incidence and severity of middle ear barotrauma. Twenty‐four patients (29.3%) required the insertion of ventilation tubes for otalgia, significantly more of whom were suffering from radionecrosis of the head and neck region (P < 0.01). Thirty‐two of the remaining 58 patients (55%) underwent specialist ENT assessment by otoscopy and tympanometry. Five ears (8%) showed the otoscopic changes of barotrauma (TEED grade 3 or 4), and one ear (2%) showed tympanometric evidence of a middle ear effusion (Type B tympanogram). We conclude that despite careful tuition in pressure equalisation and the appropriate use of ventilation tubes, up to 8% of ears sustain significant barotrauma. Tympanometry is unreliable in detecting these changes, otoscopy provides the most reliable screening

ISSN:0307-7772    

DOI:10.1046/j.1365-2273.1996.00813.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

The use of local anaesthesia for middle ear surgery is long established and has many advantages. However, it is only performed by a small number of UK otolaryngologists (20%). This lack of enthusiasm is due to concerns that patients may not tolerate the discomfort during the operation. Therefore, a survey was conducted on patients who had middle ear operations: stapedotomy, myringoplasty, ossiculoplasty and mastoidectomy. The intense sensation of noise during the operation (29.6% of patients) and anxiety (24%) were the most common discomforts, followed by dizziness (14.8$), backache (13.9%), claustrophobia (9.3%) and earache (1.9%). In spite of these discomforts, 89% of patients still preferred local anaesthesia to general anaesthesia for a similar procedure. The author suggests that good patient selection, pre‐operative explanation and the use of appropriate sedation are the important factors for local anaesthesia ear procedures to be acceptable to patient

ISSN:0307-7772    

DOI:10.1046/j.1365-2273.1996.00814.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

A series of 276 patients with a unilateral vestibular schwannoma has been analysed with respect to the factors affecting post‐operative facial nerve outcome. Age, tumour size, operative approach and the use of intra‐operative facial nerve monitoring have been examined. The tumours were removed via either a translabyrinthine or a retrosigmoid approach. In this series increasing age and increasing tumour size were associated with a worse facial nerve outcome. The use of intra‐operative facial nerve monitoring and the retrosigmoid approach were both associated with a better facial nerve outcome. Those patients having a retrosigmoid approach had a facial nerve result that was over one House grade better than those having translabyrinthine tumour re

ISSN:0307-7772    

DOI:10.1046/j.1365-2273.1996.00816.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

In previous studies investigating the influence of a heat and moisture exchanger on the respiratory and psychosocial problems of laryngectomized patients, the value of regular use of such a device could clearly be established. However, the compliance with the use of these devices was not optimal, mainly due to problems related to the plaster and to the often troublesome combination of these HMEs with a voice prosthesis. Therefore, a prospective, clinical trial was undertaken to investigate whether the use of a newly developed heat and moisture exchanger (HME, Provox® stomafilter) could improve the acceptibility of such a device. In total, 19 patients participated in this study, 13 men and six women. Vocal rehabilitation was achieved with a Provox® voice prosthesis in all patients. Each of the patients was provided with a supply of HMEs for a 3‐week trial period. The results showed that all patients were clearly positive about the valve used for digital occlusion of the stoma. Voicing was considerably facilitated and the intelligibility improved. Problems experienced in previous studies related to the adhesive tape, such as skin irritation, inadequate adherence and loosening of the plaster by coughing or forced expectoration, could be solved by the availability of the different adhesives included in this sys

ISSN:0307-7772    

DOI:10.1046/j.1365-2273.1996.00817.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY

摘要:

In this paper a new palatal surgical technique for the treatment of snoring is described and evaluated. All 22 patients were severe snorers with no significant obstructive sleep apnoea, as confirmed by detailed sleep studies. The aim of the surgical technique was to eliminate the vibration of the soft palate and the posterior pillars which occurs during snoring. This was achieved under general anaesthetic by making a 1.5 cm vertical full thickness incision in the soft palate from the superior pole of the tonsil towards the pterygoid hamulus using monopolar cutting diathermy. Specifically designed daily pain questionnaires were completed by the patients during the first 2 post‐operative weeks and the level of snoring was assessed by the patient's sleeping partner at 2, 6 and 12 weeks. The presence of any complications was also documented at these times. The results demonstrate that this surgical technique is effective, quick, simple and bloodless. The post‐operative pain created is mild and quickly resolves. All patients experienced a dramatic diminution of their snoring and in 55% complete cessation was achie

ISSN:0307-7772    

DOI:10.1046/j.1365-2273.1996.00818.x

出版商:Blackwell Science Ltd    

年代:1996

数据来源: WILEY