ABSTRACT
OBJECTIVE: An overview of common otorhinolaryngological (ORL) problems and procedures in the intensive care unit (ICU) is presented. FOCUS: Diagnostic, management, and treatment aspects of some conditions are discussed with emphasis on the potential difficulties encountered in the ICU. Approach recommendations are outlined as well as a list of required basic equipment. CONCLUSIONS: Otorhinolaryngology should be included in intensive care continuing medical education programs.
Subject(s)
Critical Care/methods , Otorhinolaryngologic Diseases/diagnosis , Otorhinolaryngologic Diseases/therapy , Causality , Ear/injuries , Humans , Intubation, Intratracheal , Mouth/injuries , Nose/injuries , Otolaryngology/education , Otorhinolaryngologic Diseases/etiology , Otorhinolaryngologic Surgical Procedures/instrumentation , Otorhinolaryngologic Surgical Procedures/methods , Practice Guidelines as Topic , Rhinitis/therapy , Sinusitis/therapy , TracheotomyABSTRACT
Neurofibromatosis type 1 (NF 1) is a syndrome with a predisposition for benign and malignant tumor development. Of the malignant neoplasms, osteogenic sarcomas are rare but have been described. There are some reports of patients with neurofibromatosis type 1 with a parathyroid adenoma and hyperparathyroidism. Also, there are studies that imply that the parathyroid hormone plays a role in the regulation and modulation of oseogenic sarcomas in vitro. We report about a 50-year-old female suffering from neurofibromatosis type 1, with a 3-year documented history of untreated hyperparathyroidism and a parathyroid adenoma. The patient developed a mandibular osteogenic sarcoma. To our knowledge, this is the first reported case occurring in the mandible. The unusual tumor site for a patient with neurofibromatosis type 1, the conjugation with hyperparathyroidism and the rapid growth of an osteogenic sarcoma are intriguing.
Subject(s)
Bone Neoplasms/complications , Hyperparathyroidism/complications , Neurofibromatosis 1/complications , Osteosarcoma/complications , Bone Neoplasms/pathology , Bone Neoplasms/therapy , Combined Modality Therapy , Female , Humans , Middle Aged , Osteosarcoma/pathology , Osteosarcoma/therapyABSTRACT
OBJECTIVE: To evaluate the audiometric results and surgical findings of revision stapedectomy in Israel. STUDY DESIGN: Retrospective. SETTING Tertiary referral center and private otology practice. PATIENTS: Seventy-eight patients over 13 years. RESULTS: A total of 78 patients were evaluated during a mean follow-up time of 1.5 years. Ten patients with far advanced otosclerosis or dizziness were then excluded. Closure of air-bone gap to within 10 dB was achieved in 67.6% of patients. Pure tone average (PTA, 500-4,000 Hz) improvement in hearing was 22.5 dB. Operative findings at time of revision were prosthesis malfunction (42.6%), incus necrosis (22%), incomplete stapedectomy (11.8%), and fistula (l.5%). Sensorineural hearing loss occurred in one patient. The technique of revision involved regrafting the oval window and the use of a piston prosthesis. CONCLUSIONS: The surgical findings and results in this study are similar to those in other large studies. Although success was less than in primary stapedectomy, the results justified revisions. Hearing gains were dependent on surgical findings, the number of previous revisions, and associated ossicular problems.
Subject(s)
Postoperative Complications/surgery , Stapes Surgery , Adolescent , Adult , Aged , Audiometry, Pure-Tone , Female , Humans , Israel , Male , Middle Aged , Ossicular Prosthesis , Reoperation , Retrospective StudiesABSTRACT
OBJECTIVE: To determine whether there has been an increase in ciprofloxacin-resistant pseudomonas malignant otitis externa, and if this has increased the morbidity of the disease. STUDY DESIGN: Retrospective. SETTING: Tertiary referral center. PATIENTS: Twenty-eight patients over 13 years. RESULTS: The records of a total of 28 patients who were admitted between 1988 and 2001 with the diagnosis of malignant otitis externa were reviewed. Seven patients had ciprofloxacin-resistant pseudomonas on their hospital culture and sensitivity test. Five of the 7 resistant cases appeared in the last 3 years, as opposed to 2 of the 7 who appeared in the 10 years before that period. In our series, there is a significant trend developing over time of pseudomonas resistant to treatment with ciprofloxacin. No increased morbidity or mortality was found in the ciprofloxacin-resistant pseudomonas group compared with the remaining patients who were sensitive to ciprofloxacin. CONCLUSIONS: In our series, resistance to ciprofloxacin in patients with malignant otitis externa is increasing over time. This may have an impact on the relatively successful outpatient treatment of these patients in the past decade. A return to inpatient or outpatient intravenous treatment with third-generation cephalosporins/antipseudomonal penicillins and more frequent debridement will be required in these patients.
