The effects of disclosure of sequential rhinomanometry scores on post-septoplasty subjective scores of nasal obstruction: a randomised controlled trial.

OBJECTIVE: We sought to evaluate the effects of awareness of rhinomanometric results on subjective sensation of nasal breathing in patients after septoplasty. DESIGN: Prospective randomised study. SETTING: Clinical Hospital Rijeka. PARTICIPANTS: A study of 60 patients (45 M, 15 F) who underwent septoplasty was performed at the ENT Clinic, Clinical Hospital Rijeka. The patients were randomised into two groups; group A was shown their rhinomanometry scores at 3 months postoperatively, while group B remained unaware of their rhinomanometry results. MAIN OUTCOME MEASURE: The assumption is that in the same settings patients aware of their rhinomanometric results have better performances of their Nasal Obstruction Symptom Evaluation (NOSE) scale and thereby a better quality of life (QOL) after septoplasty. RESULTS: The differences in rhinomanometric results and NOSE scale prior and after septoplasty were statistically significant (P < 0.001), all patients achieving better results after the operation. There was no statistically significant difference in resistance (F = 0.004; P = 0.948) and improvement of rhinomanometry results in postoperative measurements (F = 0.110; P = 0.896) between groups A and B. The symptoms measured by the NOSE scale were the same in both groups preoperatively and 1 month after septoplasty (F = 2.906; P = 0.094). Three months postoperatively in group A, the NOSE scale score was lower (M = 11.67; sd = 12.34) than in group B (M = 27.50; sd = 18.04). CONCLUSIONS: The results suggest that disclosing information to patients about their post-septoplasty rhinomanometry results may improve subjective nasal breathing, and thus improve their QOL.

The significance of rhinomanometry in evaluation of postlaryngectomy olfactory rehabilitation by polite yawning technique.

OBJECTIVE: To corroborate the result of postlaryngectomy olfactory rehabilitation evaluating the efficacy of the Polite Yawning Technique (PYT) with rhinomanometry and odours with the Smell diskettes Olfaction test (SDOT). MATERIALS AND METHODS: Thirty-two laryngectomised patients were subjected to olfactory rehabilitation consisting of 15-minute training and independent exercising for two weeks. The sense of smell and nasal airflow in laryngectomised patients were examined before and after implementation of PYT. RESULTS: The differences in SDOT results prior to and after introduction of PYT were statistically significant, most patients achieving better results after rehabilitation. A significant positive correlation was obtained in results of SDOT and rhinomanometry prior to and after introduction of PYT. The results of measurements after rehabilitation showed that 75% of patients had improved nasal breathing, 78% of patients had a better sense of smell and 40% of patients became normosmic. CONCLUSIONS: PYT has proved to be an effective method in olfaction rehabilitation following total laryngectomy. Using rhinomanometry, evaluation of the rehabilitation success is substantiated while the technique is simplified.

Cartilage palisade tympanoplasty and diving.

OBJECTIVE: To determine whether a patient with a serious defect of the tympanic membrane (TM) will be able to dive after surgery. PATIENTS AND METHODS: The authors describe three patients who were divers with serious defects of the TM (more than 75% of TM). In all three cases, cartilage palisade tympanoplasty was used to reconstruct the TM. RESULTS: Six months after surgery, the patients passed clinical examinations, audiograms (hearing restored to normal), tympanometry (increased stiffness of the TM), and pressure tolerance tests in hyperbaric chamber (30-m immersion was simulated for 4 minutes), and they began to dive again. Approximately 2 years after the surgery, all three patients are able to dive without any difficulties. CONCLUSION: The authors conclude that patients can dive after cartilage palisade tympanoplasty.

Polymethyl-methacrylate implants in forehead and supraorbital arches reconstruction: retrospective study.

Frontobasal injuries and some other diseases of frontal sinuses sometimes require radical surgery with the obliteration of the sinus. A cosmetic correction of the forehead and supraorbital arches has to be performed after such a procedure. Nowadays, there is a wide choice of alloplastic materials on the market. We tried polymethyl methacrylate implants in correction of the exterior appearance of the forehead and supraorbital arches and followed the behaviour of the implants up to 25 years after surgery. The result was 18 (94.7%) successful implantations and one failure (5.3%) with a mild sagging of the borders of the implant. Polymethyl-methacrylate proved pliable for work and modelling, not invasive for the organism and stable. In conclusion, the cure of some frontobasal injuries and diseases with the first surgical step followed by cosmetic correction of the forehead and supraorbital arches (2nd surgical step) using this alloplastic material provides a safe, durable and aesthetically satisfactory solution for the patient.

Gastroesophageal reflux, allergy and chronic tubotympanal disorders in children.

The purpose of this study is to examine the relation between gastroesophageal reflux and allergy as possible causes of chronic tubotympanal pathology. The 30 examined children (ages 2-13) were divided into two groups based on the otological criteria. The 16 examined children suffered from a secretory otitis, which lasted more than four months. Upon further examination with a microscope, seven of these children exhibited symptoms of the adhesive process of the middle ear. Furthermore, 14 patients suffered from a recurrent otitis, i.e. more than five cases of otitis per year, while five patients from this group suffered from a chronic otitis with a central defect of the tympanum. The method used for the examination of the gastroesophageal reflux consisted of a continual 24 h esophageal pH monitoring. The particular apparatus used for this included antimony electrode (Synetics Medical, Sweden), while the analysis we performed was processed through the PC software program Gastrosoft Inc. The reflux index higher than five was considered pathological. At the time of the gastroesophageal reflux examination, we also performed the allergological analysis. The presence of allergy was confirmed by three methods: the positive allergological anamnesis, the positive skin pick test and by the elevated quantities of specific IgEs (Pharmacia CAP system). The examination resulted in the following: 18 of the examined children suffered from the pathological gastroesophageal reflux (60%); further seven of our patients tested positive on the allergological test (23%); and the four who tested positive for allergy also suffered from the pathological gastroesophageal reflux (13%). In comparison with allergies, the pathological GER was substantially more frequent in the patients who suffered from chronic tubotympanal disorders.

The role of electromyography in the diagnosis of velopharyngeal insufficiency: our experiences.

The subject of this study is the electromyographic investigation of the velopharyngeal sphincter structures. Seventy-five patients underwent examination, both patients with symptoms of velopharyngeal insufficiency and patients who were thought to have latent pathological sphincter changes based on local findings. A control group of 10 healthy examinees was also investigated. On the basis of electromyographic findings we divided patients into 2 groups: 57 patients without neuromuscular disorders and 18 patients with neuromuscular disorders of the velopharyngeal sphincter. Twelve patients from the latter group had acute, and 6 had chronic lesions of the velopharyngeal sphincter. Particular cases of illness within these 2 groups were investigated further. This study shows the usefulness of electromyography for diagnosing the exact causes of velopharyngeal insufficiency and for choosing the best approach to treatment.