New modification of hot-water irrigation in the treatment of posterior epistaxis.

BACKGROUND: Tamponade treatment for epistaxis is painful and traumatic to the nasal mucosa, and may necessitate hospitalization for several days. Hot-water irrigation (HWI) was introduced as a treatment of epistaxis more than 100 years ago. In a previous study the treatment proved to be effective, less painful, and less traumatic, and required a shorter hospital stay than tamponade treatment. However, HWI has the risk of aspiration during treatment. To minimize this risk, a special catheter has been designed. OBJECTIVES: To evaluate the modified HWI and to compare the results with tamponade treatment, with respect to patient compliance, effectiveness, recurrence of bleeding, pain, complications, and length of hospital stay. PATIENTS: A total of 122 patients, hospitalized for posterior epistaxis, were randomized to receive either HWI or tamponade treatment. RESULTS: In the HWI group, 31 (55%) of the patients could be discharged from the hospital after the initial treatment only, compared with 29 (44%) of the patients treated with tamponade. Using a 10-cm visual analog scale, the mean pain score during treatment was 4.7 in the HWI group compared with 7.5 in the tamponade group. The mean hospital stay was 2.9 days for the HWI group vs. 4.0 days for the tamponade group. After discharge from the hospital, necrosis or synechia was found on rhinoscopy in 12 patients (40%) in the tamponade group compared with none in the HWI group. CONCLUSIONS: Compared with tamponade treatment, HWI is as effective, requires a significantly shorter hospital stay, is less traumatic to the nose, and is significantly less painful.

[Hot water irrigation in the treatment of posterior epistaxis]. / Varmtvandsskylning som behandling af posterior epistaxis.

Tamponade treatment in epistaxis is painful and the patient needs hospitalisation. Irrigation with hot water was introduced as a treatment of epistaxis 100 years ago. This study compares the two treatments with respect to effect, recurrence, pain, and length of hospital stay. Forty-four consecutive patients with posterior epistaxis were randomized to receive treatment with either hot water (HWI) or tamponade. In the group of patients treated with HWI, the treatment had to be stopped in seven patients (33%) because of lack of cooperation; nine patients (43%) could be discharged from hospital with no need for further treatment, whereas five patients (24%) had recurrent epistaxis requiring additional tamponade treatment. Among patients treated with tamponade, 14 patients (61%) could be discharged from hospital with no need for further treatment, while nine patients (39%) had recurrent epistaxis requiring additional tamponade treatment. Compared with the tamponade treatment, HWI is almost as effective, the hospital stay is shorter, and the treatment is significantly less painful.

Hot-water irrigation as a treatment of posterior epistaxis.

The commonly-used tamponade treatment for posterior epistaxis is painful and the patient may need hospitalization for several days. Irrigation with water of 50 degrees C was introduced as a treatment for posterior epistaxis more than 100 years ago. This study compares the two treatment modalities with respect to effect, recurrence, pain, and length of hospital stay. Forty-four consecutive patients with posterior epistaxis were randomized to receive treatment with either hot water (21 patients) or tamponade (23 patients). In the group of patients treated with hot water, the treatment had to be stopped in seven patients (33%) because of lack of cooperation; nine patients (43%) could be dismissed from hospital with no need for further treatment, whereas five patients (24%) had recurrent epistaxis requiring additional tamponade treatment. Among the patients treated with tamponade, 14 patients (61%) could be dismissed from hospital with no need for further treatment, while nine patients (39%) had recurrent epistaxis requiring additional tamponade treatment. The median stay in hospital was five days for the group treated with hot water, and six days for the group treated with tamponade. Compared to the tamponade treatment, hot-water irrigation is almost as effective, the hospital stay is shorter, and the treatment is significantly less painful.

Septic cavernous and lateral sinus thrombosis: modern diagnostic and therapeutic principles.

The incidence of both lateral and cavernous sinus thrombophlebitis has been significantly reduced in the antibiotic era. Since septic cavernous sinus thrombosis (CST) is mainly a complication of facial abscesses and septic lateral sinus thrombosis (LST) is almost invariably due to chronic otitis media, both conditions are of clinical relevance to the otolaryngologist. The predominant bacterium in septic CST is Staphylococcus aureus whereas in septic LST the bacteriology is very similar to that found in chronic otitis media. The diagnosis of septic CST can be established in most cases after thorough clinical examination, and contrast computerized tomography (CT) using the coronal projection usually confirms the clinical diagnosis. The signs and clinical course of septic LST are non-specific and the final diagnosis rests upon radiological investigations including CT-scan. The treatment of both conditions consists of broad-spectrum antibiotics, including beta-lactamase resistant penicillin in cases of septic CST. Most cases of septic LST also require surgical intervention. Two cases of septic intracranial sinus thrombosis are presented. The need for early diagnosis and treatment of this potentially lethal condition is emphasized.

Haematoma and abscess of the nasal septum.

Fifty-two patients with a haematoma or abscess of the nasal septum underwent surgical treatment during a period of 10 years in the ENT Department at Aalborg Hospital. Of these, 27 patients with a haematoma and 12 patients with an abscess were re-examined. In all the patients except 1, trauma was the cause of the lesion. The average delay of treatment was 48 hours for patients with a haematoma and 11 days for patients with abscesses. All these lesions were incised under general anaesthesia and treated with drainage and nasal packing. Eight patients showed cartilage resorption; none had initial cartilage implantation. Follow-up showed that 7 patients had received further surgical treatment during the observation period (mean 44 months). The frequency of nasal deformities is comparable with that of previous reports. The patients with abscesses in particular showed severe external nasal deformities; this is mainly attributable to the delay in treatment.

Primary malignant lymphoma of the salivary glands.

Five cases of primary malignant lymphomas of the salivary glands are reported. Four lymphomas arose in the parotid gland and one in the submandibular gland. All were non-Hodgkin lymphomas. In 4 cases the lymphomas were of low-grade malignancy, viz. 2 immunocytomas and 2 centroblastic/centrocytic malignant lymphomas, and 1 was a T-immunoblastic malignant lymphoma of high-grade malignancy. Four patients with localized disease were treated with radiotherapy and 1 patient with disseminated disease was treated with chemotherapy. One patient died from a disease unrelated to the malignant lymphoma, and 4 patients were alive at 66-136 months after treatment.

Routine radiological examination of the sinuses before septoplasty.

Records of septoplasties performed during the last five years were reviewed with the aim of evaluating the results of routine pre-operative radiological examination of the sinuses. A positive correlation was found between the information of sinusitis within the last two years and the radiological finding of complete density or fluid. The roentgenograms showed normal conditions in 73 per cent of the cases and various degrees of pathology in 27 per cent; no case showed signs of malignancy. Puncture and irrigation or sinoscopy had been performed in 52 per cent of the cases with pathological X-rays. Following this treatment, surgery was postponed in 12 patients, and in nine patients a drainage tube was placed in the maxillary sinus peroperatively. Complications developed post-operatively in five of these nine patients and it is concluded that septoplasty should have been postponed. We find that it is important to identify the four per cent (12 + 9) of patients in whom the radiological findings are so pronounced that operation ought to be postponed.

Sensorineural hearing loss in chronic adhesive otitis.

The incidence and degree of sensorineural hearing loss were analyzed in 67 patients operated on for adhesive otitis. Median observation time was 11 years. The difference in bone conduction between the treated ear and the untreated ear was assessed for each frequency, before operation and late after operation. A sensorineural hearing impairment of 5 dB was found in the frequency region of 500 to 2,000 Hz and of 10 dB at 4,000 Hz. The hearing did not deteriorate during the postoperative period. In 76% of the patients, the bone conduction in the treated ear compared with the healthy ear was at least 10 dB poorer at one or more frequencies. There are great problems in analyzing sensorineural hearing loss in chronic otitis, which often is or has been bilateral.

Hepatosplenomegaly in infectious mononucleosis, assessed by ultrasonic scanning.

The present study aims at an assessment of hepato-splenomegaly in infectious mononucleosis (IM). In 29 patients admitted to the ENT department with IM, based on the typical clinical and laboratory findings, including a positive mononucleosis test in most cases, the size of the liver and spleen was estimated by ultrasonic scanning on days 1, 3, 5, 10, 20, 30, 90 and 120 after admission. A control group of eight patients with peritonsillar abscess was included for comparison. The results showed that all patients had an enlarged spleen (mean enlargement: 50-60 per cent) but only a few were palpable. Half of the patients had enlargement of the liver (5-20 per cent), which was palpable in only 8 per cent. There was no correlation between the size of the spleen and that of the liver, not between the changes in the size of these organs. There was no enlargement of the liver or spleen in the control group. No correlation was found between the size, or changes in the size, of the organs and blood values such as lactatdehydrogenase and aspartatamino-transferase. There is, however, a striking parallelism between the curves for these parameters, which might indicate that the organs as well as the blood tests return to normal within 28 days. If this holds true, our warning to abstain from physical exercise and alcoholic intake may be limited to a period of about 1 month.

Nasal fractures in children--long-term results.

An open reduction of nasal fractures in children is more burdensome for the patient, and for the department, than a closed reduction. We therefore made a follow-up examination of 79 patients, undergoing closed reduction of nasal fractures during the period from 1966 through 1975. Mean observation time was 11 years. A control group of 82 subjects was similarly examined. Among the patients, 52% had deformities of the external nose, compared with 22% in the control group - only 7 (9%) of the patients had severe deformities. Septal deviation occurred in 38% of the patients and 40% of the controls. A total of 6 patients in the fracture group were admitted for reoperation; none were readmitted from the control group. We conclude that the results of closed reduction are satisfactory, and that the results of larger, controlled studies must be awaited before the present treatment method is changed.

Long-term results of septoplastic operations.

161 patients treated with septoplastic operations for nasal stenosis were examined 25-64 months postoperatively. Surgery was inadequate in 32 cases (20%); in 23 this was due to the septum operation itself, in 9 to unsatisfactory or no correction of the alar insufficiency. Preoperative anterior dislocations were corrected in 64 of 76 cases, deflection of the nose in 43 of 75 cases. Late complications were few: anterior dislocations in 3 cases; small columellar retractions in 7 cases; small septal perforations in 4 cases, and saddle nose deformity in 3 cases. 35% of the patients were not satisfied with the result, but in 14 patients (9%) this was not justified according to our examination. In a further 11% the reasons for dissatisfaction were not related to the result of the operation.

Diclofenac (Voltaren). Pain-relieving effect after tonsillectomy.

The efficacy of diclofenac suppositories was estimated in a two-centre, double-blind, placebo-controlled study comprising 97 patients (47 in the diclofenac group and 50 in the placebo group). The series from the two centres and patients in the two treatment groups were comparable. Immediately postoperatively, the patients received 100 mg diclofenac, followed by 50 mg in the evening and 50 mg in the morning after the operation, or placebo suppositories. The efficacy was assessed both by the patients and by the staff by marking on a visual analogue scale. Statistical analyses showed that diclofenac has a significant (p less than 0.001) effect on the pain associated with swallowing and on the general condition of the patients. The therapeutic gain was calculated to 50%. As a consequence of this study, treatment with diclofenac has been introduced in both ENT departments.

Sensorineural hearing loss in posttraumatic incus dislocation.

In 34 posttraumatic incus dislocations, the initial sensorineural hearing loss (primary) after the trauma and that 11 years after trauma (late) were analyzed. Primary hearing loss measurements following the trauma showed that 53% of patients had sensorineural hearing loss of more than 10 dB for at least one of the frequencies from 1,000 to 4,000 cps, 18% for more than 30 dB. For late hearing loss after the trauma, the corresponding percentages were 50% and 15%, respectively. No reliable progression of the posttraumatic sensorineural hearing loss was found, although a few exceptions were seen. It may be concluded that sensorineural hearing loss is not a progressive disorder of the inner ear.