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European Actuarial Journal     Hybrid Journal   (2 followers)
European Archives of Oto-Rhino-Laryngology     Hybrid Journal   (3 followers)
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European Biophysics Journal     Hybrid Journal   (4 followers)
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European Clinics in Obstetrics and Gynaecology     Hybrid Journal   (4 followers)
European Food Research and Technology     Hybrid Journal   (8 followers)
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European Journal for Philosophy of Science     Partially Free   (4 followers)
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European Journal of Clinical Microbiology & Infectious Diseases     Hybrid Journal   (7 followers)
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European Journal of Nutrition     Hybrid Journal   (16 followers)
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European Journal of Plant Pathology     Hybrid Journal   (2 followers)
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European Archives of Oto-Rhino-Laryngology    [5 followers]  Follow    
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
     ISSN (Print) 1434-4726 - ISSN (Online) 0937-4477
     Published by Springer-Verlag Homepage  [2187 journals]   [SJR: 0.737]   [H-I: 37]
  • Endoscopic airway management of acute upper airway obstruction
    • Abstract: Abstract The conventional treatment for patients with acute upper airway obstruction is tracheostomy, which is a safe, definitive procedure in most hands. Alternatively, a debulking procedure can be considered but this requires both surgical and anaesthetic skill and expertise. However, where possible, it provides a good alternative with the advantages of removing the cause of obstruction and yielding tissue for histopathological analysis, and avoiding the need for a tracheostomy, with its associated morbidity. We evaluated all patients who presented with acute upper airway obstruction and underwent endoscopic laser debulking surgery performed by the senior author, over a three and a half year period. We recorded patient demographic data, their underlying pathologies, complication rates associated with laser debulking surgery and the conversion to tracheostomy. Thirty patients were identified, including 19 males and 11 females, with a mean age of 57.10 ± 17.20 years (19–93 years). All patients underwent debulking procedures with carbon dioxide laser under general anaesthetic. All patients had their underlying diagnosis confirmed from their debulking surgery. Twelve patients were found to have benign pathology and 18 had malignant airway obstruction. There were no laser-associated complications. One patient required conversion to emergency tracheostomy, during their debulking surgery. Endoscopic laser assisted debulking surgery has successfully been used to establish a safe airway. It allows obtaining tissue specimens, to confirm the underlying diagnosis, thus avoiding the need for further biopsies under anaesthetic. For all malignant cases, patients were subsequently able to proceed to definitive treatment. It has obviated the need for emergency tracheostomy in almost all of the cases in our patient cohort.
      PubDate: 2014-05-01
  • Degree of myelination (       class="a-plus-plus">g-ratio) of the human
           recurrent laryngeal nerve
    • Abstract: Abstract The g-ratio (estimated by dividing the axon diameter by the myelinated fiber diameter) can be useful to the evaluation of the relationship between nerve conduction velocity and fiber morphology during peripheral nerve regeneration. However, there is little detailed information about the g-ratio of the human recurrent laryngeal nerve (RLN), especially between men and women. The objective of this study was to investigate the g-ratio of the RLN by quantifying histomorphometric data (axon diameter and myelinated fiber diameter) in the RLN of men and women. The RLN was bilaterally studied in human specimens obtained from necropsies (seven men and seven women). The nerves were analyzed using histology, and the morphometric parameters were measured using Image Pro-Plus Software (Image Pro-Plus 6.0; Media Cybernetics, Silver Spring, MD, USA). When compared with the RLN of the women, the parameters of the RLN of the men are significantly larger, as shown by the axon diameter (19.0 %) (P = 0.0001), myelinated fiber diameter (7.1 %) (P = 0.0497), and g-ratio (12.5 %) (P = 0.0005). Our findings demonstrated that there are morphological asymmetries between the g-ratio (degree of the myelination) of the masculine and feminine RLN. These morphological findings are probably related to physiological differences.
      PubDate: 2014-05-01
  • Minimally invasive pocket technique for the implantation of Neurelec
           Digisonic SP cochlear implant
    • Abstract: Abstract The aim of this report is to describe and evaluate the reliability of a minimally invasive pocket (MIP) technique for the implantation of the Neurelec Digisonic SP cochlear implant. The skin incision is made at the back of the auricular concha. The device fixation and stability relies on natural pericranial pressure by the creation of a narrow subperiosteal pocket. There’s no need for any additional fixation. In our institution, 19 patients underwent cochlear implantation using the MIP technique. Age ranged from 18 months to 73 years. The patients were reviewed for surgical implantation technique, intra- and postoperative complications, and postoperative hearing results. All patients were successfully implanted with a secure fixation. The MIP technique is particularly interesting to apply in young children.
      PubDate: 2014-05-01
  • Endonasal resection of early stage squamous cell carcinoma of the nasal
    • Abstract: Abstract The squamous cell carcinoma of the nasal vestibule (SCCNV) is a comparatively rare malignant disease. It occurs in the transition zone at the limen nasi. The choice of treatment for small tumors is a matter of controversy. Due to better cosmetic results, radiation therapy is usually recommended, however some recent reports have suggested that early stage tumors are equally or even more effectively managed by surgery. There was no standardized surgical procedure applied in these studies, though. The goal of our investigation was the retrospective evaluation of patients with a T1 or T2 carcinoma of the nasal vestibule who were treated surgically with an endonasal, endoscope-controlled approach at our ENT clinic between 2008 and 2010. Given the rarity of SCCNV, the 10 included cases represent the largest group of patients with early stage SCCNV treated primarily surgically by an endonasal approach so far. Our study shows that the endonasal resection of an early stage vestibular carcinoma seems adequate as a possible therapy. In the follow-up observation period no local or loco-regional recurrence was observed. The external cosmetic damage and endonasal scarring do not appear to be pronounced even following cartilage resection and were regarded as not seriously disadvantageous.
      PubDate: 2014-05-01
  • Natural evolution of an eardrum bridge in patients with a traumatic
           eardrum perforation
    • Abstract: Abstract Although the “eardrum bridge” of traumatic tympanic membrane perforations (TMPs) is very little seen, the underlying natural evolution during the healing process are still unknown.The aim of this retrospective study was to evaluate the natural evolution of the “eardrum bridge” of TMPs. The data for 36 patients with barotrauma-associated traumatic TMPs with an “eardrum bridge” between January 2006 and December 2007 were retrieved. The eardrum bridge was completely liquefied due to infection in one patient. The bridge gradually became necrotic and incorporated into the new eardrum in four patients, and the healed eardrum formed a retraction pocket. In nine patients, epithelial hyperplasia occurred on both sides of the eardrum bridge at the edges, and the bridge became incorporated into the new eardrum, which became very thin over time. However, in 22 patients, the eardrum bridge gradually became necrotic, finally forming a yellow crust-like substance and migrating to the external auditory canal (EAC); it was not incorporated into the new eardrum. The closure of the perforation depended on stratified epithelial migration at the perforation edges near the eardrum bridge, resulting in a normal morphology of the healed eardrum. The present study shows that the eardrum bridge has a different natural evolution during the healing process in patients with a TMP. Most eardrum bridges gradually became necrotic and migrated toward the EAC, and stratified epithelial migration occurred at the perforation edges near the eardrum bridge and closed the perforation. However, a few eardrum bridges gradually became necrotic or developed epithelial hyperplasia, then became incorporated into the new eardrum, resulting in the formation of a retraction pocket and the development of atrophy. Thus, long-term follow-up and histological examination of a larger sample is necessary.
      PubDate: 2014-05-01
  • The role of antibiotic therapy and nasal packing in septoplasty
    • Abstract: Abstract Both systemic antibiotic therapy and nasal packing are used frequently in septoplasty. Nevertheless, there is still great disagreement among authors around the real advantages with regard to the efficacy of both of these procedures in septal surgery. The aim of the present review was to evaluate the more recent data published on this topic. One appropriate string was run on PubMed to retrieve articles dealing with the topics mentioned above. A double cross-check was performed on citations and full-text articles found using the selected inclusion and exclusion criteria. Overall, the articles we analyzed indicated the poor utility of routine antibiotic therapy and nasal packing during septoplasty, the latter procedure producing more complications than advantages. In conclusion, on the basis of the recent literature, the use of systemic antibiotic prophylaxis and nasal packing in septal surgery seems to be a non-rational procedure.
      PubDate: 2014-05-01
  • Use of quantitative diffusion-weighted magnetic resonance imaging to
           predict human papilloma virus status in patients with oropharyngeal
           squamous cell carcinoma
    • Abstract: Abstract Although identification of human papilloma virus (HPV) status in oropharyngeal squamous cell carcinoma (OPSCC) is essential in predicting treatment response, no imaging modality can currently determine whether a tumor is HPV-related. In this retrospective study, 26 patients with OPSCC confined to the lateral wall or the base of tongue underwent neck magnetic resonance imaging, using T1-, T2- and diffusion-weighted imaging (DWI). Apparent diffusion coefficients (ADCs) in a region of interest covering the largest available primary tumor area of OPSCC on a single slice of the ADC map were calculated using two b values (0 and 1,000 s/mm2). Mean and minimum ADCs were compared with HPV status, using p16 immunohistochemistry as a surrogate marker for HPV infection. Mean and minimum ADCs for HPV+ OPSCC were significantly lower than those for HPV− OPSCC. A cut-off value of mean ADC for HPV+ OPSCC of 1.027 × 10−3 mm2/s yielded sensitivity and specificity of 83.33 and 78.57 %, respectively. In conclusion, the present study indicates that ADC could be used to predict HPV status in patients with OPSCC.
      PubDate: 2014-05-01
  • Incidence and localization of abnormal mucosa findings in patients
           consulting ENT outpatient clinics and data analysis of a cancer registry
    • Abstract: Abstract For patients without symptoms and at risk, there is no established early detection program to discover carcinomas of the upper aerodigestive tract in the sense of secondary prevention. Such type of prevention seems even more desirable because the chances for a cure and the quality of life are strongly dependent on the stage of the tumor and the time of the initial diagnosis. Six hundred and eight patients without symptoms but at least one of the self-reported risk factors “smoking”, “alcohol consumption” or “reflux” were examined with an endoscope or an optical microscope for pathological findings in the upper aerodigestive tract once a year. In addition, the incidence of malignancies of the upper aerodigestive tract between 2001 and 2010 was determined through the Cancer Registry of Schleswig–Holstein. Tissue samples were taken from 18 of the 608 patients. Eleven patients (1.8 %) had a squamous cell carcinoma. Another patient suffered from non-Hodgkin’s lymphoma and one from larynx tuberculosis. The ratio of detected malignancies in the oral cavity and the oropharynx on the one hand and the hypopharynx and larynx, which can only be examined by endoscopes, on the other hand were in our cohorts and in our survey according to the cancer registry was 5/6. The above-described methods allow examining risk patients easily and safely. According to current publications, the ratio of the found malignancies exceeds the expected ratio significantly, which presumably was caused by the examination targeting patients at risk. Due to the expanded examination area using optical instruments more than doubles the rate of discoverable malignancies compared to the limitations posed by the examination of directly visible areas of the oral cavity of the oropharynx.
      PubDate: 2014-05-01
  • Comparative analysis of resection tools suited for transoral
           robot-assisted surgery
    • Abstract: Abstract Introduction of transoral robot-assisted surgery (TORS) has a strong potential to facilitate surgical therapy of head and neck squamous cell cancer (HNSCC) by decreasing the indication for an external surgical approach. However, the availability of resection tools is limited and comparative studies in the context of TORS are not available. In the context of the newest da Vinci Si HD® robotic system, various dissection methods were compared in a surgical animal model using porcine tongue at three different sites representing mucosal, muscular and lymphatic tissue. Resection methods included (a) CO2 laser tube, (b) flexible fiber Tm:YAG laser, (c) monopolar blade, and (d) radio frequency (RF) needle. Specimens were formalin-fixed, paraffin-embedded, cut, and stained with haematoxylin–eosin. Dissected tissue was examined for the width of the incision as well as the individual coagulation zone of each tool at various tissue sites. In addition, instrument costs and performance were determined. The incisions made by the RF needle had the most favourable cutting width and also smaller coagulation defects, as opposed to other tools, granting the best preservation of tumour-adjacent structures and improved pathological assessment. Instrument performance was best evaluated for CO2 laser and RF needle, whereas financial expenses were lowest for RF needle and monopolar blade. Improvement and modification of resection tools for TORS become a relevant criterion in order to facilitate routine usage in the surgical therapy of HNSCC. A consequent decrease in surgical mortality and improved precision of surgical tumour resection could lead to a significant clinical growth potential of TORS.
      PubDate: 2014-05-01
  • Sandwich grafting technique for endoscopic endonasal repair of
           cerebrospinal fluid rhinorrhoea
    • Abstract: Abstract The surgical management of cerebrospinal fluid (CSF) rhinorrhoea has changed significantly after the introduction of functional endoscopic sinus surgery. The clear anatomical exposure of the roof of the nasal and paranasal sinus cavities by the endoscope offers the surgeon a golden chance to identify the area of CSF leak, and thus enables one to adequately plan the management. The aim of this work is to evaluate the use of facia lata sandwich graft technique for endoscopic endonasal repair of CSF rhinorrhoea. Forty patients with CSF rhinorrhoea were treated endoscopically using 2 layers of facia lata (underlay and onlay) interposed with a layer of septal cartilage or conchal bone in-between (sandwich technique) for repair. Fifty-five percent of cases were regarded as spontaneous CSF leaks with no obvious cause, 30 % following head injury and 15 % were iatrogenic. The ethmoidal roof was the commonest location of CSF leak (60 %) followed in frequency by the cribriform plate and the sphenoid sinus (20 % each). Follow-up period was 12–24 months. We have achieved a 95 % success rate in managing CSF leaks in our 40 patients in the first attempt repair and 100 % success rate after second attempt repair. Endoscopic endonasal repair of CSF leaks is quite safe and effective procedure with high success rate and avoid the morbidity associated with craniotomy. Using the three-layer, sandwich-grafting technique of facia lata further adds more security to the sealing of CSF and augments the results of repair.
      PubDate: 2014-05-01
  • Otomycosis in the north of Iran: common pathogens and resistance to
           antifungal agents
    • Abstract: Abstract Otomycosis as a kind of external otitis can be caused by various species of fungi. To use the appropriate treatment, it is necessary to identify the causal agent of otomycosis. The aim of this study was to determine the pathogens that caused otomycosis and also the efficacy of different antifungal agents. 100 patients with diagnosis of otomycosis/otitis extern were entered in this study. Bacterial culture was performed by eosin methylene blue agar, blood agar; and Sabouraud dextrose agar was used to culture the fungal agents. Minimum inhibitory concentration test also was performed to determine the efficacy of Clotrimazole, Fluconazole, Ketoconazole and Nystatin on the fungal pathogens. Otomycosis was confirmed in 43 % of patients by positive culture. The most prevalent fungal pathogen was Aspergillus niger which was sensitive to Clotrimazole, Fluconazole, Ketoconazole. Candida albicans was sensitive to all drugs, in which, the most sensitivity was due to fluconazole. The most frequent fungal pathogen in our otomycosis cases is A. niger, and most of fungi that caused otomycosis are sensitive to clotrimazole.
      PubDate: 2014-05-01
  • Endoscopic cochlear implant procedure
    • Abstract: Abstract The objective was to asses the feasibility of the endoscopic technique for cochlear implant (CI) positioning avoiding mastoidectomy and to discuss the benefits and drawbacks of the technique. The study design is a surgical procedure description and prospective case series report. From December 2011 to October 2012, six patients underwent endoscopic CI. All cases were selected based on CT and MRI studies. All surgical steps were analyzed; intra-and post-operative complications were noted. The length of time for each surgical procedure was recorded. The surgical procedure was described step by step focusing on the anatomy of the round window (RW) niche, analyzing the critical point during the dissection. The timing of the surgical procedures was 120 ± 21 (mean ± SD) min. In 1/6 patients, intra-operative injury of the chorda tympani occurred. In all cases, an endoscopic identification was performed and the anatomical details of the RW niche were noted. In 6/6 cases, a RW niche magnification was performed endoscopically. 5/6 cases showed a normal conformation of the RW. In 1/6 patients, obliteration of the RW niche was found. In 4/6 patients, an endoscopic cochleostomy through the RW was performed. In 1/6 patients, a difficult insertion of the array was observed. The current follow-up is 7.3 months (SD ± 3.7). No post-operative short- or long-term complications were noted in this series. Endoscopic CI is a safe and viable technique with a low rate of complications and with good outcomes.
      PubDate: 2014-05-01
  • Tension pneumocephalus as a result of endonasal surgery: an uncommon
           intracranial complication
    • Abstract: Abstract Tension pneumocephalus (TP) is a clinical entity characterized by continued build-up of air within the cranial cavity, leading to abnormal pressure exerted upon the brain and subsequent neurologic deterioration, due to development of a mass effect and potentially a herniation syndrome. Intracranial complications of endoscopic sinus surgery (ESS) and other endonasal procedures are fortunately very rare, occurring in less than 3 % of cases. We report 4 cases of small bone defects (<3 mm) in the anterior cranial base accompanied by TP, caused by ESS and other endonasal procedures. The pathophysiology and management of this clinical entity is discussed with a pertinent literature. Four patients with small (<3 mm) skull base defects were identified. All patients presented with active cerebrospinal fluid leaks. CT scans showed intracranial tension pneumocephalus. Using image-guided endoscopic techniques, all defects were addressed with multi-layer repair. Closure was achieved in all patients on the first attempt, with an average follow-up of 36 months. Tension pneumocephalus is a rare event that can occur as a result of traumatic or iatrogenic violation of the dura and should be considered in all patients presenting with altered mental status after endoscopic sinus surgery or other surgical and diagnostic procedures that violate either the cranial or spinal dura. Because of the potential for rapid clinical deterioration and death, prompt brain imaging is warranted to rule out the diagnosis, and urgent neurosurgical consultation is indicated for definitive management.
      PubDate: 2014-05-01
  • Using coronary computerized tomographic images to predict the bulging
           second genu of the facial nerve in mastoidectomy
    • Abstract: Abstract The aim of the present study is to determine whether coronary CT images of the temporal bone are useful to predict a bulging second genu of the facial nerve (SGFN) in mastoidectomy by measuring and comparing the heights of the SGFN above the prominence of the lateral semicircular canal (PLSC) in medial-to-lateral dimension on coronary CT images and in mastoidectomy. The relationship between the SGFN and the PLSC in medial-to-lateral dimension, which may have big variability, can be evaluated on the coronary CT images of the temporal bone. The heights of the SGFN above the PLSC in medial-to-lateral dimension were measured on coronary CT images and in mastoidectomy in 184 patients. If the SGFN is above the PLSC in medial-to-lateral dimension, we called the SGFN a bulging SGFN. The data measured on CT images and in surgery were described in histograms and compared. The sensitivity and the specificity in the diagnosis of a bulging SGFN on CT images were calculated by comparison with surgical measurement. Cohen’s kappa coefficient was calculated. The heights of the SGFN above the PLSC measured in medial-to-lateral dimension varied from −2.9 to 2.9 mm on coronary CT images and varied from −3.0 to 3.0 mm in surgery. The data measured in surgery showed that the SGFN was above the PLSC in medial-to-lateral dimension in 27.7 % (51/184) patients, at least 1 mm above the PLSC in 15.8 % (29/184) patients and at least 2 mm above the PLSC in 6.0 % (13/184) patients. The sensitivity and the specificity for CT diagnosis of a bulging SGFN were 100 % (51/51) and 91.0 % (121/133), respectively. Bulging SGFN can be predicted by measuring the height of the SGFN above the PLSC on coronary CT images of the temporal bone.
      PubDate: 2014-05-01
  • The use of a mandibular repositioning device for obstructive sleep apnea
    • Abstract: Abstract The objective of this study was to verify the effect of a mandibular repositioning device (MRD) on polysomnographic parameters and on the mean electromyographic activity of the masseter and temporal muscles in individuals with obstructive sleep apnea syndrome (OSAS). This is a prospective cohort study conducted at multidisciplinary OSAS center in a tertiary referral center. Nineteen individuals with mild or moderate OSAS associated with Mallampati 3–4 were treated with an MRD during sleep. The subjects underwent diurnal electromyography (EM) and nocturnal polysomnography (PSG) examinations both prior and after initial treatment (3 months with MRD for PSG and 6 and 12 months of treatment for EM). The examinations performed at different times were compared. Comparison of the initial and final polysomnography examination revealed a significant mean reduction of apnea–hypopnea index (AHI) from 13.8 to 7.8. The successful treatment rate with the MRD was 52.6 %, and the improved treatment rate was 68.4 %. Patients with lower pre-treatment AHI presented higher rates of cure. There was no statistically significant change in electromyography examination among different times. The MRD reduced the apnea–hypopnea index in individuals with enlarged base of tongue and mild and moderate OSAS without damaging the function of the masseter and temporal muscles as determined by electromyography.
      PubDate: 2014-05-01
  • The role of colour duplex sonography in preoperative perforator mapping of
           the anterolateral thigh flap
    • Abstract: Abstract The anterolateral thigh (ALT) flap was first described in 1984. It is now widely used in reconstructive surgery following extensive tumour resection in head and neck cancer. Routine preoperative perforator mapping is recommended due to variability of the vascular anatomy of the flap. A wide array of diagnostic tools is available for this purpose, including colour duplex sonography (CDS). In this study, we report our experience with CDS. The number, location, and course (myocutaneous or septocutaneous) of ALT perforators were assessed by CDS prior to reconstructive surgery in 22 patients with head and neck cancer. These data were compared with the intraoperative anatomical findings to assess agreement and reliability. The positive predictive value and sensitivity of CDS in detecting perforator location was 89.4 and 94.4 %, respectively, when compared to the surgical report. CDS also identified the perforator course with 100 % accuracy. Colour duplex sonography is an effective, non-invasive, and relatively inexpensive technique for assessing the location of skin perforators.
      PubDate: 2014-05-01
  • Effectiveness of olfactory rehabilitation according to a structured
           protocol with potential of regaining pre-operative levels in laryngectomy
           patients using nasal airflow-inducing manoeuvre
    • Abstract: Abstract This pilot study aims to evaluate the effectiveness of the Nasal Airflow-Inducing Manoeuvre (NAIM) when employing a structured protocol as well as investigate if early rehabilitation has the potential to return olfaction to pre-operative levels in patients undergoing laryngectomy following laryngeal cancer. Prospective study of cases conducted during 1 year, 2009–2010, at the Department of Ear-, Nose and Throat at Sahlgrenska University Hospital, Gothenburg, Sweden. Ten patients with laryngeal cancer and about to undergo laryngectomy were identified, of which four were included in the study. The remaining six patients were unfit to participate (n = 4) or declined participation (n = 2). Testing was conducted pre- and post-operatively and at each NAIM training session. Patients received three initial NAIM sessions followed by reinforcement training at 3, 6 and 12 months. Measures included Scandinavian Odour-Identification Test (SOIT), a semi-structured interview and questionnaires including European Organisation for Research and Treatment of Cancer, QLQ-C30 and QLQ-H&N35. All patients were normosmic smellers according to SOIT at the study end-point. One patient reported higher SOIT scores at 12 months follow-up compared to pre-operatively. Remaining patients had scores close to that reported pre-operatively. Using subjective measures, olfaction improved in all patients with one patient’s final score surpassing pre-operative scores. By implementing a structured protocol consisting of three training sessions early following laryngectomy with additional reinforcement sessions at 3, 6 and 12 months, NAIM is effective in terms of improving smelling ability. There also appears to be potential for restoring olfaction to a patient’s pre-operative level as reflected by both olfactory testing and PRO instruments. However, larger studies are needed to further explore the findings highlighted by this study.
      PubDate: 2014-05-01
  • Revisiting Down syndrome from the ENT perspective: review of literature
           and recommendations
    • Abstract: Abstract Down syndrome is the most common chromosomal abnormality among live born infants reaching up to 1 in 700 births and is characterized by a variety of dysmorphic features and medical conditions. The potential to reach their full developmental capacities can be hindered by ear, nose, and throat problems. Hence, knowledge of the various anatomic peculiarities that predispose them to various medical conditions is fundamental. The medical states resulting from these variations and suggested treatment options are reviewed. Such conditions include refractory otitis, eustachian tube dysfunction, laryngomalacia, tracheal stenosis, obstructive sleep apnea, hearing loss, and voice and articulatory impairments. This review revisits besides the otolaryngeal pathologies, special medical considerations in Down’s syndrome patients that might affect surgical outcomes used in the management of the above pathologies.
      PubDate: 2014-05-01
  • Erratum to: Head and neck surgical patients; is it time for a bridle
    • PubDate: 2014-05-01
  • Use of a microsecond Er:YAG laser in laryngeal surgery reduces collateral
           thermal injury in comparison to superpulsed CO       class="a-plus-plus">2 laser
    • Abstract: Abstract Despite causing significant thermocoagulative insult, use of the carbon dioxide (CO2) laser is considered gold standard in surgery for early stage larynx carcinoma. Limited attention has been paid to the use of the erbium:yttrium–aluminium-garnet (Er:YAG) laser in laryngeal surgery as a means to reduce thermal tissue injury. The objective of this study is to compare the extent of thermal injury and precision of vocal fold incisions made using microsecond Er:YAG and superpulsed CO2 lasers. In the optics laboratory ex vivo porcine vocal folds were incised using Er:YAG and CO2 lasers. Lateral epithelial and subepithelial thermal damage zones and cutting gap widths were histologically determined. Environmental scanning electron microscopy (ESEM) images were examined for signs of carbonization. Temperature rise during Er:YAG laser incisions was determined using infrared thermography (IRT). In comparison to the CO2 laser, Er:YAG laser incisions showed significantly decreased epithelial (236.44 μm) and subepithelial (72.91 μm) damage zones (p < 0.001). Cutting gaps were significantly narrower for CO2 (878.72 μm) compared to Er:YAG (1090.78 μm; p = 0.027) laser. ESEM revealed intact collagen fibres along Er:YAG laser cutting edges without obvious carbonization, in comparison to diffuse carbonization and tissue melting seen for CO2 laser incisions. IRT demonstrated absolute temperature rise below 70 °C for Er:YAG laser incisions. This study has demonstrated significantly reduced lateral thermal damage zones with wider basal cutting gaps for vocal fold incisions made using Er:YAG laser in comparison to those made using CO2 laser.
      PubDate: 2014-05-01
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