ABSTRACT
The treatment of supraglottic carcinoma remains a controversial issue. Five accepted surgical and non-surgical oncological treatments have been currently established: standard horizontal supraglottic laryngectomy (HSL), supraglottic CO2 laser microsurgery (TLM), transoral robotic surgery, radiotherapy alone and radiotherapy in combination with chemotherapy. Some studies have shown that complications of head and neck surgeries increase significantly in patients over 65 years compared to younger patients. We designed a retrospective analysis to assess the rate of complications and functional outcomes of patients treated by TLM and HSL in cases of T1-T3 supraglottic squamous cell carcinomas (SCC) in a tertiary University Hospital. Results were compared between patients younger and older than 65 years. We found significant differences in the rate of aspiration pneumonia (p = 0.026), mean time to decannulation (p = 0.001) and mean hospital stay (p = 0.007) in patients treated by TLM, which was higher and longer in the group of patients over 65 years of age. Regarding HPL, we only found significant differences in the mean time to decannulation (p = 0.001), which was longer in the group of patients younger than 65 years. According to our results, TLM or HPL can both be a safe surgical option for patients older than 65 years, but previous evaluation of lung function before surgery is mandatory because of an increased risk of aspiration pneumonia in patients with lung problems, especially when treated by TLM. Concerning functional outcomes in patients older than 65 years, TLM reduces the postoperative rate of tracheostomy, mean time required for decannulation and mean hospital stay compared with HPL. However, no significant difference in the occurrence of aspiration pneumonia, dysphagia or in the mean length of NGT feeding was found.
Subject(s)
Carcinoma, Squamous Cell/surgery , Glottis , Laryngeal Neoplasms/surgery , Laryngectomy/methods , Laser Therapy , Microsurgery , Aged , Aged, 80 and over , Humans , Laser Therapy/methods , Microsurgery/methods , Middle Aged , Mouth , Recovery of Function , Retrospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: The aim of this study is to value the hearing results obtained in our department following stapedectomy and the reasons of primary failures. MATERIAL AND METHOD: We present a retrospective study of 95 stapedectomies in 82 patients, performed from January 1997 to September 2002 at Hospital Xeral-Cies of Vigo (Pontevedra). RESULTS: Medium presurgical audiometric threshold was 65.71 and postsurgical 26.68. Good results were obtained in 84.21% of cases (air-bone gap closure difference under 20 dB), 10.52% had not change in air threshold and the rest deteriorated. CONCLUSIONS: We compare our results with other authors and we consider that stapedectomy is a safe surgical technique, but it has important complications and they have to be bear in mind to prevent them.
Subject(s)
Stapes Surgery , Adult , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies , Treatment FailureABSTRACT
Tympanoplasty is the surgical technique used to restore the anatomy and function of the middle ear. The tympanoplasty type I or myringoplasty is performed when the ear only has a perforation of the tympanic membrane without any ossicular damage. We present a retrospective study started in 1997 and finished in 2000 with a total of 118 cases who had undergone a myringoplasty along this period of time. The percentage of closure was 85.59% (n = 101). The techniques used were underlay in a 60.16% of the patients (n = 71), overlay in 34.74% (n = 41) and sandwich in 5.08% (n = 6). In the paediatric patients (under 14 years of age) the percentage of a successful graft following surgery was 88% and in the adults 83.87%. More than fifty years have passed. Since Zöllner and Wullstein described for the first time this type of surgery important because of its good results.
Subject(s)
Myringoplasty , Adolescent , Adult , Age Factors , Aged , Chi-Square Distribution , Child , Data Interpretation, Statistical , Female , Humans , Male , Middle Aged , Myringoplasty/methods , Retrospective StudiesABSTRACT
For the last two years we have been testing a protocol for early diagnosis of acoustic schwannoma. We analyzed the results obtained in outpatients of the ENT clinic for ten months. Using the protocol described 10.7% accurate diagnoses, were obtained although in only one diagnosis was made in the intracanalicular stadium that was susceptible to ENT surgery.
Subject(s)
Clinical Protocols , Cranial Nerve Neoplasms/diagnosis , Neuroma, Acoustic/diagnosis , Vestibulocochlear Nerve/pathology , Adult , Audiometry, Pure-Tone , Cranial Nerve Neoplasms/pathology , Cranial Nerve Neoplasms/surgery , Electronystagmography , Female , Hearing Loss, Sensorineural/diagnosis , Humans , Male , Middle Aged , Neuroma, Acoustic/pathology , Neuroma, Acoustic/surgery , Tomography, X-Ray Computed , Vestibulocochlear Nerve/surgeryABSTRACT
Personal opinions on surgery of polyps of the nasal cavity and paranasal sinuses, including from simple polypectomy to ethmoid microsurgery and nasal endoscopic surgery. The diagnostic importance of tomodensitometry and the essential postsurgical care are emphasized. The results of 29 patients with polyps of the nasal cavity and paranasal sinuses treated with intranasal microsurgery and endoscopic surgery are reported.
Subject(s)
Endoscopy/methods , Microsurgery/methods , Nasal Polyps/surgery , Ethmoid Bone/surgery , Hemorrhage/etiology , Humans , Postoperative ComplicationsABSTRACT
OBJECTIVE: Evaluation of the chronometry test as a screening procedure for hypoacusia compared with tonal audiometry, in patients over 65 years. DESIGN: Cross-sectional study. SETTING: Mariañamansa health area (Ourense). PATIENTS: The first 49 patients over 65 who came to the medical consultations in June and July 1992 were selected, irrespective of the reasons for their visit; there were 17 males and 32 females, with and average age of 72.4 +/- 4.6 and 71.9 +/- 4.5. Only one patients consulted directly about loss of hearing. MEASUREMENTS AND MAIN RESULTS: A statistically significant association was found between the chronometry test and the audiometry test (gold-standard), significant at p < 0.005 for the left ear and p < 0.05 for the right ear. The test achieved a sensitivity of 0.85 and specificity of 0.76 in the case of the left ear, and 0.84 (sensitivity) and 0.56 (specificity) for the right ear. The kappa rate was 0.55 for the right ear and 0.67 for the left ear, showing agreement that went well beyond chance. CONCLUSIONS: In our view, the chronometry test constitutes an cheap, effective, simple, and replicable procedure for the detection of hypoacusia in patients aged over 65, and one which can usefully be used when no audioscope is available.
