occult ENT hazards in ICU patients

The comatosed patient is a disabled subject. The defense reflexes [e.g. sneezing and coughing] are impaired. Most of the care is directed towards the vital signs, blood gases monitoring and care of chest. The aim of this study is to detect the possible hazards that affect the upper respiratory tracts of comatosed ICU patients to reach useful conclusions for the E.N.T. care needed for them to avoid these hazards. Our study was done upon 34 comatosed ICU patients. We found that sinusitis, mainly caused by Gram-ve bacteria and anaerobes, was a common complication [50%], mostly the maxillary sinus. Tympanogram type B, indicating M.E.E, was a common finding [24%]. Nasal intubation increased the incidence of sinusitis and MEE markedly, and was mostly on the ipsilateral side. Laryngotracheal complications were found in 12 [35%] cases, and the most frequent complication was tracheal stenosis then vocal cord granuloma and immobility. All cases with laryngotracheal complications were having endotracheal intubation [nasal or oral] especially when two intubations [gastric and endotracheal] were present in the same patient. The incidence of sinusitis, MEE,and laryngotracheal complications were significantly correlated with the duration of intubation, nasal and/or throat colonization on admission, pneumonia and association of general diseases. This study showed that daily E.N. T. examination is mandatory for ICU patients for the early detection of complications. The sinusitis and pneumonia were mostly caused by Gram-ve bacilli and anaerobes and this must be met with the proper antibiotics. CT scan on the nose and paranasal sinuses is mandatory on admission and serially thereafter for the early detection and treatment of hidden sinusitis. Oral intubation is preferred nasal intubation, avoid high-pressure cuff, avoid endotracheal reintubation if possible, the intubation must be as shorter as possible and avoid double intubation in the same patient [endotracheal and gastric]. Tracheostomy is preferred [in the first 7 days], tympanometry are mandatory to detect Eustachian tube obstruction, MEE or infection. Serial PH monitoring of the pharynx, for early detection of gastro-esophageal reflux, is essential and the ICU staff must be aware of the occult E.N.T. hazards of coma

Doppler sonography of vertebral arteries in young patients with vertigo - without apparent otogenic causes

Forty-eight young patients with vertigo without apparent otogenic causes were investigated to determine values of blood flow velocities and hemodynamic changes in extra-cranial vertebral arteries [VAS]. Color flow Doppler ultrasonography was used for the detection of a possible cause of vertigo in these cases. Electronystagmography was done to correlate its findings with that of vertebral arteries Doppler blood flow [VABF] and to study accuracy and reliability of this recent tool of investigation. A significant slow VABF was reported in vertigo group compared with the control group. Velocity of vertebral artery in 54.2% of the cases showed abnormal findings; a laterality group in 29.2% and the group with lower circulatory velocity in 25%. In about 67% of cases, the results of Doppler and ENG were in good agreement with each other. The ENT results of most of the cases of the laterality group were recorded to be of a central disorder

Assessment of posterior pharyngeal wall augmentation in cases of velopharyngeal insufficiency by conchal cartilage graft

Posterior pharyngeal wall augmentation is an effective method for correcting mild to moderate cases of VPI. This was done on 12 patients with VPI by using a conchal cartilage with its perichondrium which was harvested from the ear. Localization of the site of implantation was determined using nasoendoscopy. This surgical technique carries many advantages as it allows more augmentation of the posterior pharyngeal wall due to the archiform shape of the conchal cartilage which is easily taken without donor side morbidity and easy to be harvested. A larger sample is needed with long-term follow up periods. Also, the phoniatric assessment of these cases showed that the proper selection of cases with mild or moderate degrees of open nasality is essential for using this technique

Doppler sonography of vertebral arteries in patients with tinnitus but normal hearing

Thirty-six patients with tinnitus but normal hearing [as proved by pure-tone audiometry and immittancemetry] were investigated to determine the values of the blood flow velocities and the hemodynamic changes in the extra-cranial vertebral arteries [VAS]- by color flow Doppler ultrasonography-for the detection of a possible cause of tinnitus in these cases. Further investigations were done to correlate their findings with that of vertebral arteries Doppler blood flow [VABF] and to study the accuracy and reliability of this recent tool of investigation. Abnormal Doppler findings could be detected in 15 cases. A significantly slow VABF was reported in tinnitus group compared with the control group