ABSTRACT
OBJECTIVE: To determine the optimal stimulus paradigm, electrode orientation, and configuration of an implantable stimulator used to reanimate the posterior-cricoarytenoid (PCA) muscle in case of bilateral vocal fold paralysis (BVFP). STUDY DESIGN: Acute studies were conducted on 13 canines implanted with Itrel II systems with or without PCA innervation. PCA stimulus-response characteristics were obtained by measuring stimulated vocal fold displacement endoscopically. RESULTS: The denervated PCA was only 10% to 25% as responsive to stimulation as the innervated PCA. However, the response could be increased to 38% and 61% if the Itrel was modified to deliver 1 and 2 msec pulses, respectively. Stimuli delivered centrally to the muscle 5 mm from the median raphe improved performance. CONCLUSION AND SIGNIFICANCE: The optimal stimulus paradigm identified in this study (1 msec pulses delivered at 30 to 40 Hz and 2 to 8.5 mA) has been applied to implanted BVFP patients and improved outcome. Information regarding optimal electrode orientation could also be important to future clinical trials.
Subject(s)
Electric Stimulation Therapy/instrumentation , Prostheses and Implants , Vocal Cord Paralysis/therapy , Animals , Dogs , Electrodes , Electromyography , Laryngeal Muscles/physiopathologyABSTRACT
A randomized, prospective trial was carried out to compare the rate of hemorrhagic complications after removal of nasal packing left for 24 and 48 hours. A total of 104 patients underwent nasal surgery and were randomly assigned to 1 of 2 groups: group 1, 24 hours of nasal packing; group 2, 48 hours of nasal packing. No statistical difference was observed between the groups in terms of occurrence of hemorrhagic complications. Hypertension was the only prognostic factor for postoperative bleeding. The routine use of 48-hour postoperative nasal packing after nasal surgery is not justified because of the low incidence of bleeding and the potential associated morbidity. At the end of the procedure, surgeons should evaluate the risk of postoperative bleeding (ie, presence of hypertension) and decide whether 24-hour nasal packing is enough.
Subject(s)
Nasal Septum/surgery , Nose Diseases/therapy , Postoperative Hemorrhage/therapy , Rhinoplasty/methods , Tampons, Surgical , Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
OBJECTIVE: To report clinical manifestations, diagnosis, and epidemiologic characteristics of laryngeal paracoccidioidomycosis. DESIGN: Case series. SETTINGS: Tertiary care institutional hospital. PATIENTS: We reviewed the hospital records of 7 patients with laryngeal paracoccidioidomycosis diagnosed by histopathological examination. MAIN OUTCOME MEASURE: Clinical manifestations of laryngeal paracoccidioidomycosis. RESULTS: All patients were men and were middle-aged (range, 43-65 years), and most (86% [6/7]) were farm workers. All 7 patients regularly used tobacco, but only (43% [3/7]) were alcohol users. Clinical manifestations were dysphonia (86% [6/7]), dyspnea (71% [5/7]), dysphagia (43% [3/7]), and cough (29% [2/7]). Laryngeal examination revealed ulcerative lesions with a mulberrylike appearance in 3 patients and vegetative lesions in 4 patients. Many had multiple laryngeal lesions with involvement of the true and false vocal cords, the epiglottis, and the arytenoid and interarytenoid areas. The first diagnostic impression was carcinoma in all patients. CONCLUSIONS: Laryngeal paracoccidioidomycosis may be a difficult diagnosis for the unsuspecting clinician to make. Examination of the larynx can reveal lesions similar to laryngeal cancer; therefore, diagnosis of carcinoma must be ruled out by histopathological examination or culture of a specimen.
Subject(s)
Larynx/pathology , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/physiopathology , Adult , Brazil/epidemiology , Diagnosis, Differential , Hospital Records , Humans , Laryngoscopy , Male , Middle Aged , Paracoccidioidomycosis/epidemiologyABSTRACT
Encephalocraniocutaneous lipomatosis (ECCL) is a rare congenital disorder and was first described in 1970. The main clinical features of the syndrome include convulsions beginning in infancy, mental retardation, and unilateral cutaneous and ophthalmologic lesions with ipsilateral cerebral manifestations. A 14-year-old caucasian boy with ECCL associated with otolaryngologic manifestations is reported. To our knowledge, this is the first case of ECCL with otolaryngologic manifestation in the English literature.
Subject(s)
Brain Diseases/diagnosis , Cerebellopontine Angle/abnormalities , Ear Canal/abnormalities , Epidermis/pathology , Hearing Loss, Sensorineural/diagnosis , Lipomatosis/diagnosis , Papilloma/pathology , Adolescent , Alopecia/diagnosis , Audiometry, Pure-Tone/methods , Humans , Male , Severity of Illness Index , Syndrome , Temporal Bone/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
In this study, the authors analysed retrospectively 161 patients with acquired immunodeficiency syndrome interned at the Hospital de Clinicas de Porto Alegre. 115 (71.4%) presented with otolaryngologic lesions. 92.2% were male. The great majority were white and aged between 20 and 50 years of age (88.7%). Homosexual and bisexual males were the most frequent risk group (72.2%). Oropharyngeal candidiasis was the most prevalent head and neck manifestation (86%). Other less common lesions were sinusitis (19.1%) and Kaposi sarcoma (7.8%), mainly on the hard palate. The recognition of these manifestations by the otolaryngologist is important in order to make an early diagnosis and to treat them.
