Impact of COVID-19 on a Tertiary Otolaryngology Practice in Singapore

The COVID-19 pandemic has had a major impact in healthcare systems across the world, with many hospitals having to come up with protocols and measures to contain the spread of the virus. This affects various specialties' clinical practices in many ways. Since early 2020 in Singapore, the Department of Otorhinolaryngology at Tan Tock Seng Hospital had to rapidly adapt to this pandemic as we provided services to the main healthcare facility combating the virus in our country. We had to design new workflows and also remain flexible in view of the ever-changing situation. There are 6 important domains for an otolaryngology department or any clinical department in general to consider when making adjustments to their practices in an outbreak: (1) clinical work, (2) education, (3) research, (4) safety of patients and staff, (5) morale of medical staff and (6) pandemic frontline work. We hope that the sharing of our experiences and the lessons learnt will be useful for both our local and international colleagues.

Trastornos generalizados del desarrollo en otorrinolaringología pediátrica / Pervasive development disorders in pediatric otolaryngology / Transtornos generalizados do desenvolvimento emotorrinolaringologia pediátrica

Los pacientes con TGD, presentan un variado abanico de patologías, relacionadas con los trastornos del comportamiento, del lenguaje y del desarrollo. El comportamiento de cada uno de ellos puede ser muy diferente. Es primordial llegar al diagnóstico correcto de las patologías otorrinolaringológicas, hipoacusias de conducción, neurosensoriales, ventilatorias, deglutorias y del lenguaje. Estos pacientes requieren una mayor atención y acompañamiento en la realización de los estudios diagnósticos, en el manejo del niño y su familia en la consulta y en los procedimientos quirúrgicos. Se realizará en este trabajo, un abordaje a esta patología desde todos los aspectos que involucran al otorrinolaringólogo y al equipo multidisciplinario.

Os pacientes com TGD apresentam um variado leque de patologias relacionadas com os transtornos do comportamento, de linguagem e de desenvolvimento. O comportamento de cada um deles pode ser muito diferente. É primordial chegar ao diagnóstico correto das patologias otorrinolaringológicas, hipoacusias de condução, neurossensoriais, ventilatórias, deglutórias e de linguagem. Estes pacientes requerem uma maior atenção e acompanhamento na realização de estudos diagnósticos, na maneira como lidar com a criança e a sua família durante a consulta e nos procedimentos cirúrgicos. Neste trabalho, esta patologia será abordada a partir de todos os aspectos que envolvem o otorrinolaringologista e a equipe multidisciplinar.

Patients with PDD present with a broad spectrum of impairments associated with behavior, language, and development. These patients may behave very differently from each other. Adequate diagnosis of the otolaryngology pathologies, such as conductive or sensorineural hearing loss and ventilation, swallowing, and language disturbances is of utmost importance. These patients and their families require additional care, support, and management strategies during doctor visits, when diagnostic studies are performed, and in the preparation for surgical p Discuss in this paper an approach to this disease from every aspect involving the otolaryngologist and the multidisciplinary team.

Current status of robotic surgery in Japan

The da Vinci S surgical system (Intuitive Surgical) was approved as a medical device in 2009 by the Japanese Ministry of Health, Labour and Welfare. Robotic surgery has since been used in gastrointestinal, thoracic, gynecological, and urological surgeries. In April 2012, robotic-assisted laparoscopic radical prostatectomy (RALP) was first approved for insurance coverage. Since then, RALP has been increasingly used, with more than 3,000 RALP procedures performed by March 2013. By July 2014, 183 institutions in Japan had installed the da Vinci surgical system. Other types of robotic surgeries are not widespread because they are not covered by public health insurance. Clinical trials using robotic partial nephrectomy and robotic gastrectomy for renal and gastric cancers, respectively, have recently begun as advanced medical treatments to evaluate health insurance coverage. These procedures must be evaluated for efficacy and safety before being covered by public health insurance. Other types of robotic surgery are being evaluated in clinical studies. There are several challenges in robotic surgery, including accreditation, training, efficacy, and cost. The largest issue is the cost-benefit balance. In this review, the current situation and a prospective view of robotic surgery in Japan are discussed.

Sistematización en el proceso de evaluación y terapia del pólipo de cuerda vocal: encuesta a médicos otorrinolaringólogos chilenos / Assessment and therapy process systematization of vocal fold polyps: a survey to Chilean otorhynolaryngologists

Esta investigación tiene por propósito describir las indicaciones terapéuticas, prescritas por médicos otorrinolaringólogos a pacientes diagnosticados con pólipo cordal. Se describen las etapas de evaluación, reposo vocal e indicaciones terapéuticas. El estudio intenta develar la presencia de una sistematización en el proceso anterior. Dicha información es recabada a partir de una encuesta vía mail aplicada a 29 médicos pertenecientes a la Sociedad Chilena de Otorrinolaringología (N=205). Los datos obtenidos permiten concluir que no existe un estándar en las indicaciones que se preguntan en la encuesta. Sin embargo, el total de médicos consultados manifiesta que sería útil la elaboración de protocolos para la evaluación y tratamiento de los pacientes con alteración vocal.

This research is aimed at describing the therapeutic indications, prescribed by otorhynolaryngologists polyp patients diagnosed with tailpiece, including assessment, voice rest and therapeutic indications. The study attempts to reveal the presence of systematization in the previous process. This information is collected from a survey via e-mail applied to 29 physicians belonging to the Chilean Society of Otolaryngology (n =205). The data obtained indicate that there is no standard in the information asked for in the survey. However, the total number of doctors surveyed stated that the development of protocols for assessment and treatment of patients with vocal alteration would be useful.

Semiología en otorrinolaringología / Semiology in otolaryngology

La patología otorrinolaringológica (ORL) es una de las principales causas de consulta en pediatría y su exploración semiológica exige una serie de habilidades en la técnica, además de paciencia por parte del explorador, con el fin que ésta no sea una experiencia negativa para el paciente. Se debe realizar la valoración de ORLcon el niño en brazos de la madre, recordando cada uno de los pasos en semiología. En la presente revisión, se evaluarán aspectos de la anamnesis en ORL, anatomía básica así como de la exploración física de la oreja, los oídos, la nariz, los senos paranasales, la boca, la faringe y el cuello.

Otolaryngology pathology (OTL) is one of the main causes of pediatric and semiologic exploration requires a range of skills in the art, as well as patience from the browser, so it is not a negative experience for the patient . PtÑ assessment should be conducted with the child in mother's arms, remembering every one of the steps in semiology. In the present review, we evaluated aspects of OTL history.

Otolaryngology and speech therapy evaluation in the assessment of oropharyngeal dysphagia: a combined protocol proposal / Avaliação otorrinolaringológica e fonoaudiológica na abordagem da disfagia orofaríngea: proposta de protocolo conjunto

Dysphagia is a symptom associated with an array of anatomical and functional changes which must be assessed by a multidisciplinary team to guarantee optimal evaluation and treatment, preventing potential complications. AIM: The aim of the present study is to present the combined protocol of clinical and swallowing videoendoscopy carried by ENT doctors and speech therapists in the Dysphagia Group of the ENT Department - University Hospital. MATERIALS AND METHODS: Retrospective study concerning the use of a protocol made up of patient interview and clinical examination, followed by an objective evaluation with swallowing videoendoscopy. The exam was performed in 1,332 patients from May 2001 to December 2008. There were 726 (54.50 percent) males and 606 (45.50 percent) females, between 22 days and 99 years old. RESULTS: We found: 427 (32.08 percent) cases of normal swallowing, 273 (20.48 percent) mild dysphagia, 224 (16.81 percent) moderate dysphagia, 373 (27.99 percent) severe dysphagia and 35 (2.64 percent) inconclusive exams. CONCLUSION: The combined protocol (Otolaryngology and Speech Therapy), is a good way to approach the dysphagic patient, helping to achieve early and safe deglutition diagnosis as far as disorder severity and treatment are concerned.

Disfagia é um sintoma que envolve uma gama de alterações anatômicas e funcionais, que deve ser abordado de maneira multidisciplinar para garantir melhor avaliação e tratamento, prevenindo as complicações potenciais. OBJETIVO: utilização do protocolo de avaliação clínica e videoendoscopia da deglutição, realizado em conjunto por otorrinolaringologistas e fonoaudiólogos, no Ambulatório de Disfagia da Divisão de Clínica Otorrinolaringológica da instituição. MATERIAL E MÉTODO: Estudo retrospectivo da utilização do protocolo de anamnese e exame físico otorrinolaringológico e fonoaudiológico, complementados pela videoendoscopia da deglutição. Foram avaliados 1332 pacientes no período de maio de 2001 a dezembro 2008, sendo 726 (54,50 por cento) indivíduos do sexo masculino e 606 (45,50 por cento) do sexo feminino. As idades variaram de 22 dias a 99 anos, com uma média de idade de 59,4 anos. RESULTADOS: Foram identificados 427 (32,08 por cento) pacientes com deglutição normal, 273 (20,48 por cento) com disfagia leve, 224 (16,81 por cento) com disfagia moderada e 373 (27,99 por cento) pacientes com disfagia grave, além de 35 (2,64 por cento) exames inconclusivos. CONCLUSÃO: O protocolo de avaliações otorrinolaringológica e fonoaudiológica integrado permitiu uma abordagem minuciosa e complementar do paciente disfágico, em relação a classificações do distúrbio de deglutição, além de auxiliar na abordagem terapêutica.

Comparação entre a radiografia de cavum e a cefalométrica de perfil na avaliação da nasofaringe e das adenoides por otorrinolaringologistas / Comparison between cavum and lateral cephalometric radiographs for the evaluation of the nasopharynx and adenoids by otorhinolaryngologists

INTRODUÇÃO: tanto a radiografia cefalométrica de perfil quanto a de cavum permitem a avaliação do espaço aéreo nasofaríngeo (EAN). Não é rara a solicitação dos otorrinolaringologistas de radiografia de cavum, mesmo o paciente possuindo uma cefalométrica. OBJETIVOS: objetivou-se (a) conhecer quais exames os otorrinolaringologistas solicitam para avaliar o EAN; (b) verificar o conhecimento da cefalométrica por otorrinolaringologistas; (c) comparar a avaliação de otorrinolaringologistas nas duas técnicas radiográficas para a medição e a visualização do EAN e da adenoide; (d) correlacionar os resultados do método de inspeção visual com os da medição de Schulhof. MÉTODOS: foram obtidas, no mesmo dia, radiografias cefalométricas e de cavum de 15 pacientes respiradores bucais. Essas foram cobertas com papel cartão, deixando visível apenas o EAN e adenoides e foram avaliadas por 12 otorrinolaringologistas. Estes respondiam sobre sua familiaridade com a cefalométrica, quais exames solicitam para visualizar EAN e adenoides e se utilizam algum método de medição do grau de obstrução. Avaliavam qual das radiografias apresentava a melhor visualização da adenoide e do EAN, e classificavam o tamanho dos mesmos em pequeno, médio ou grande, através de método visual. RESULTADOS: os resultados demonstraram que todos os otorrinolaringologistas costumam solicitar a radiografia de cavum. Apenas um solicita a cefalométrica, dois estão familiarizados com essa técnica e um utiliza algum método de medição do EAN. A cefalométrica foi preferida por 49,4 por cento dos otorrinolaringologistas, a de cavum por 22,8 por cento, enquanto 27,8 por cento não observaram diferença entre ambas. Foi encontrada baixa correlação entre o método de medição visual e o de Schulhof.

INTRODUCTION: The lateral cephalometric as well as the cavum radiograph allow the evaluation of the nasopharyngeal airway (NAW). Otorhinolaryngologists routinely use the cavum radiograph, even when the patient already has a lateral cephalometric headfilm. OBJECTIVES: The aim of this study was to (a) acknowledge which exams otorhinolaryngologists use for the evaluation and measurement of the NAW; (b) evaluate if the otorhinolaryngologists are acquainted to the cephalometric; (c) compare both radiographs to see which one is preferred to visualize the NAW and adenoids and (d) correlate the visual analysis to the measuring method of Schulhof. METHODS: For this purpose, the cephalometric and the cavum radiographs of 15 mouth-breathing children were taken on the same day. These radiographs were masked leaving only the NAW and the adenoids visible, and were blindly presented to 12 otorhinolaryngologists. They received the radiographs together with a questionnaire asking on their familiarity with the lateral cephalometric, which exams are used for NAW and adenoid evaluation and if they use any method for measuring the NAW obstruction level. They were also asked to visually classify the NAW and the adenoids according to their sizes into small, medium and large. RESULTS: The results demonstrated that all otorhinolaryngologists in the sample use the cavum radiograph. Only one uses the cephalometric radiograph and two are familiar to this technique. The cephalometric was preferred by 49.4 percent of the otorhinolaryngologists, the cavum by 22.8 percent and 27.8 percent did not see any difference between both methods. There was low correlation between the visual method and the Schulhof measuring method.

Foreign body nose in children presenting at a tertiary care teaching hospital in Pakistan

To determine the patient management factors and patient outcomes in pediatric patients of foreign bodies in nose. This descriptive study was performed in ENT Department, Khyber Teaching Hospital, Peshawar from February, 2006 to January, 2007. Two hundred fifty seven cases of foreign bodies in nose in patients upto 12 years of age were included. Personal data, clinical features, investigations, management details and complications were recorded on a pre-designed proforma. In younger non cooperative cases foreign bodies were removed under general anesthesia, while in cooperative children it was removed without anesthesia by using suction, use of forceps and foreign body hook. Among 257 cases of foreign bodies in nose 48.46% were between 4 to 8 years, with male preponderance i.e. 63%. Unilateral and bilateral presentations were seen in 95% and 5% cases respectively. Most common foreign body types were plastic beads, pearls, pieces of sponge and small round objects. There were two cases of alkaline battery lodged in the nose. General anesthesia had high success rate. Round shape foreign bodies and younger children are associated with poor outcome with removal attempts made under direct visualization. These cases should be referred directly to otolaryngologists for removal under general anesthesia

Relación entre las maloclusiones y la respiración bucal en pacientes que asistieron al Servicio de Otorrinolaringología del Hospital Pediátrico San Juan de Dios; junio de 2005 / Relationship between malocclusions and mouth breathing in patients who attended the ORL Service of the Juan de Dios Pediatric Hospital, June 2005

La Insuficiencia Respiratoria Nasal es una condición patológica que se presenta con relativa frecuencia en los pacientes que acuden a consulta odontológica y de otorrinolaringología. Estos pacientes adquieren una postura adaptativa de las estructuras de la cabeza y la región del cuello, que afectan la relación de los maxilares y el desarrollo normal de la oclusión. El propósito del presente estudio fue demostrar si existe relación entre los pacientes con Insuficiencia Respiratoria Nasal y un tipo específico de maloclusión dentaria utilizando la clasificación de Angle. Así mismo se planteó como propósito interrelacionar el área de odontología con la de otorrinolaringología, con el fin de establecer un sistema de referencias de un área a otra para brindar una atención integral. El estudio se realizó, en 39 niños que asistieron al servicio de otorrinolaringología del Hospital San Juan de Dios en el mes de Junio de 2005, de edades comprendidas entre 6 y 12 años, de ambos sexos y que presentaban problemas otorrinos que causaran respiración bucal. A estos pacientes se les realizó el examen clínico bucal para determinar las maloclusiones presentes. Los resultados no evidenciaron relación entre la Insuficiencia Respiratoria Nasal y una maloclusión específica. Hubo una marcada presencia de apiñamiento anteroinferior, de mordidas abiertas y de características propias de la fascie adenoidea. El tipo de maloclusión predominante fue la Clase I y el principal problema de otorrinolaringología causante de insuficiencia respiratoria nasal fue la Hipertrofia Adenotonsilar.

Nasal Respiratory Insufficiency is a frequent disease in patients suffering from odontological and ORL conditions. These patients acquire an adaptive posture of the head and neck structures affecting the relationship between the maxilla, the mandible and the occlusion normal development. The purpose of this study was to demonstrate the existence of a relationship between Nasal Respiratory Insufficiency and a specific type of dental malocclusion using Angle's classification. Another purpose was to integrate the Dental and ORL fields in order to establish a reference system between both specialties. The study included 39 children of either sex, 6 to 12 years-old. They were treated during June 2005 at the ORL Department of the San Juan de Dios Hospital. They presented ORL conditions which also caused oral respiration. They were studied to determine the existence of dental malocclusion. The results did not show any relationship between Nasal Respiratory Insufficiency and malocclusion. The predominant malocclusion type was Class I and the main ORL pathology causing Nasal Respiratory Insufficiency was Adenotonsilar Hypertrophy.

A modified hearing aid fitting procedure using both real ear and 2cc coupler measurement system

In order to reduce the test time in real ear hearing-aid fitting for children, the validity of applying the average real ear to coupler differences (RECDs) in prefitting procedure using a 2cc coupler measurement system was evaluated by checking whether the majority of people's RECDs might occur within 5 dB of the average RECDs (N = 116) in each test frequency and age group. The percentages of occurrence were around 90% in test subjects' RECDs in saturation sound pressure levels (SSPLs) and around 70% in gain in each important test frequency. Appropriate test frequencies in prefitting are 500, 1000, 1500 and 2000 Hz.

Estenosis subglótica adquirida: experiencia en 80 casos: Hospital Niños "J. M. de los Ríos" / Adquire subglotic stenosis: experience in cases: Hospital of Niños \"J. M.\" of the Rios

La Estenosis Subglótica Adquirida es una entidad que afecta a tejidos blandos y estructuras cartilaginosas del espacio subglótico. Desde enero de 1987 hasta agosto de 1995, ingresaron al servicio de ORL del Hospital de Niños "J.M de Los Ríos" 80 pacientes con esta patología. El 87 por ciento (70) ameritaron traqueotomía y el 13 por ciento (10) no necesito tratamiento alguno. De los 70 pacientes traqueotomisados el 77 por ciento (60), se les realizó dilatación más infiltración de esteroides. al 10 por ciento (8), se les practicó laringotraqueoplastia, 2 pacientes fallecieron. El 75 por ciento (45) de los traqueotomisados fueron decanulados y dados de alta. El 25 por ciento (15) de los pacientes se mantienen en tratamiento. Fueron decanulados el 75 por ciento (6) de los 8 pacientes a los cuales se les realizó laringotraqueoplastia; y el 25 por ciento (2) no han podido ser decanulados por regresión de la estenosis.