Idiopathic Subglottic and Tracheal Stenosis: A Survey of the Patient Experience.

OBJECTIVES: To report and compare patients' experiences with acquired subglottic stenosis (AS) versus idiopathic subglottic and tracheal stenosis (ISTS). METHODS: A survey was made available to patients with AS and ISTS. Results were analyzed for inter- and intragroup differences using a 2-tailed t test. RESULTS: The study included 160 survey participants (AS n = 28; ISTS n = 132), with a predominance of female participants (82% AS, 98% ISTS). Acid reflux was the most prevalent comorbidity across groups (42%-43%). A significant difference in time to diagnosis was found between groups, with 32% of AS patients diagnosed within 3 months of symptom onset, compared to 2% with ISTS. A diagnosis delay greater than 18 months occurred for 58% of ISTS patients. There was no difference in treatment approach, with the most common treatment being balloon dilation, followed by laser dilation. Tracheal resection was performed in 36% of patients in both groups. Patient satisfaction with surgical outcomes was significantly higher after tracheal resection (76%) compared to other treatment modalities (39%). CONCLUSIONS: ISTS remains a diagnostic challenge as highlighted by the delay in diagnosis compared to AS. There appears to be no historical or symptomatic factors specific to ISTS. Additionally, patients report increased satisfaction and symptom resolution after tracheal resection.

Medical hypnosis as a tool to acclimatize children to noninvasive positive pressure ventilation: a pilot study.

BACKGROUND: Patient cooperation is crucial for the success of noninvasive positive pressure ventilation (NPPV). This study evaluated the efficacy of medical hypnosis to reduce anticipatory anxiety and acclimatization time in children who are candidates for long-term NPPV. METHODS: Medical hypnosis was performed by a trained nurse. The acclimatization time and long-term compliance with NPPV were evaluated. RESULTS: Hypnosis was performed in nine children aged 2 to 15 years. Seven children had a high level of anticipatory anxiety because of a tracheotomy since birth (n=2), a history of maxillofacial surgery (n=2), severe dyspnea because of lung disease (n=2), and morbid obesity and depression (n=1), and two children with obstructive sleep apnea failed standard NPPV initiation. The hypnosis techniques were based on distraction in the youngest patient and indirect or direct hypnotic suggestions in the older children to obtain a progressive psychocorporal relaxation. All patients accepted the interface and the NPPV after the first hypnosis session. A median of three sessions was needed for overnight (>6 h) NPPV acceptance. The 6-month compliance with NPPV was excellent, with a median use of 7.5 h per night. CONCLUSION: Medical hypnosis is an effective, safe, noninvasive, and inexpensive tool for reducing the anticipatory distress and acclimatization time for NPPV. This therapy is particularly useful in children with traumatic experiences, such as a tracheotomy or facial surgical procedures.

[Assessment of degree of psychological health involvement in pre-laryngectomized patients]. / Valoración del grado de afectación sobre la salud psíquica en el paciente prelaringectomizado.

INTRODUCTION AND OBJECTIVE: Several authors have found increased anxiety in patients the day before an intervention and its correlation with anxiety levels the post-operative period. In this study, we determined a number of problems to which patients who underwent total laryngectomy often objected: the tracheostomy, being left without a voice and it being an aggressive, major surgery. Our objective was to assess the degree of anxiety and fears of the patient prior to total laryngectomy. MATERIAL AND METHODS: We compared 2 groups of 20 patients who underwent operation for total laryngectomy and for other ENT pathologies. On the day before the operation, we collected demographic and medical data and administered the Spanish versions of the Folstein Mini-Mental State Examination (MMSE) and the Goldberg General Health Questionnaire (GHQ-28). We also investigated whether the patients had any fear or fear of surgery and what that fear was. RESULTS: Completion of the MMSE revealed cognitive impairment in only one patient. We subsequently conducted the GHQ-28 and found psychological distress in 20-25% of our cases. When the different fears in both groups were compared by X(2), the results were not statistically significant. CONCLUSIONS: Total laryngectomy causes the loss of oral communication and impairs self-image, contributing to a strong emotional reaction. It is essential to have effective rehabilitation, which considers all aspects of health-sickness, such as the recovery of spoken language, social aspects and the psychological characteristics, vital for proper comprehensive patient management.

Apoyo social percibido en hombres operados de cáncer de laringe / Perceived social support in male laryngectomized patients

En este trabajo, se realiza un estudio sobre el apoyo social percibido en una muestra de hombres operados de cáncer de laringe, realizando comparaciones con una muestra de hombres sanos, y valorando la percepción de las parejas de los hombres de ambas muestras. Los objetivos son evaluar el apoyo social percibido por los hombres operados de cáncer de laringe y establecer las diferencias respecto al apoyo social percibido entre el grupo de hombres sanos y el de operados de cáncer de laringe. La muestra se compone de 25 hombres operados de cáncer de laringe, 25 hombres sanos, 15 mujeres que eran pareja de los hombres diagnosticados de cáncer de laringe y 15 mujeres que eran pareja de los hombres sanos. Para la evaluación del apoyo social percibido, utilizamos el ISEL de Cohen et al (1983). Principalmente, encontramos que los hombres laringectomizados perciben el apoyo informacional como el menos accesible para ellos, siendo el instrumental y el emocional los que perciben en mayor medida. Entre los hombres laringectomizados y los hombres sanos, tan solo encontramos diferencias respecto a la percepción del apoyo social de tipo instrumental (AU)

It is studied the level of perceived social support in a sample of male subjects operated for larynx cancer by conducting comparisons with a sample of healthy males and assessing the perception of the partners of both groups of men. The objectives are to assess the perceived social support by men operated for larynx cancer and establish the differences with respect to the perceived social support between the group of healthy males and that of the cancer patients. The sample consisted of 25 males operated for larynx cancer, 25 healthy males, 15 female partners of the males diagnosed with cancer and 15 female partners of the healthy males. To assess perceived social support, we used the ISEL of Cohen et al (1983). Our main fi nding was that laryngectomized males perceive informational support as the least accessible to them, while they perceive instrumental and emotional support the most. Between laryngectomized and healthy males we only found differences in relation to the perception of social support of an instrumental nature (AU)

[Invasive and non-invasive ventilation in conflict with best palliative care in severe COPD]. / Invasive Beatmung und nicht-invasive Beatmung im Konflikt mit bester palliativer Versorgung bei schwerer COPD.

This example of an 80-year-old patient with severe lung disease and respiratory failure demonstrates the difficult relationship between the patient's needs, physical symptoms, and social problems. This man decides after a prolonged and difficult in-patient treatment actively for home ventilation rather than die of respiratory failure. He opts for tracheostomy and invasive ventilation because he cannot handle non-invasive mask-ventilation sufficiently by himself. It requires professional communication and support to gain the acceptance of family and caregivers for home ventilation. A survey of existing data on end of life decision-making in end-stage lung disease is given.

Sexual problems after total or partial laryngectomy.

OBJECTIVES: To investigate sexual problems that can occur after laryngeal and hypopharyngeal cancer surgery and to specify possible influencing factors. STUDY DESIGN: Multi-institutional cross-sectional study. METHODS: Two hundred six patients were interviewed in person using the European Organization for Research and Treatment of Cancer, Quality of Life Questionnaire, Head and Neck Module (EORTC QLQ-H&N35), the Hospital Anxiety and Depression Scale, and a structured interview assessing alcohol and tobacco consumption, sociodemographic data, and specific sexual problems. Type of surgery, tumor site, and tumor stage were documented according to the participants' medical records. Multivariate analysis of variance was used to assess the independent impact of each factor. RESULTS: More than half of the patients in our study reported having reduced libido and sexual enjoyment after treatment. Sixty percent considered it an important issue for their contentment with life. Sexual difficulties were found to be unrelated with gender, formal education, alcohol and tobacco consumption, type of surgery (partial vs. total laryngectomy), radiotherapy, and tumor site. Psychological distress (F = 46.27, P < .001) was seen to have a strong independent impact on the occurrence of sexual difficulties and stage of disease (F = 4.50, P < .05) and age (F = 4.79, P < .05), a moderate independent impact. CONCLUSIONS: Reduced libido and sexual enjoyment is a common problem after laryngeal and hypopharyngeal cancer surgery. However, it is not caused by the oncological treatment but rather by the cancer itself. Depression is often associated with sexual problems. Both should be discussed in medical consultations with head and neck cancer patients when appropriate to provide adequate treatment.

Clinical predictors of quality of life in patients with head and neck cancer.

OBJECTIVE: To identify clinical predictors of quality of life (QoL) in a head and neck cancer patient population. DESIGN, PATIENTS, AND SETTING: A convenience sample of 570 patients with upper aerodigestive tract cancers were surveyed at a tertiary care oncology clinic and Veterans Affairs otolaryngology clinic. INTERVENTIONS: A self-administered health survey was constructed to collect demographic, health, smoking, alcohol, depression symptom, and QoL information. Tumor site and tumor stage, clinical, and treatment data were abstracted from the patient medical records. MAIN OUTCOME MEASURES: Quality of life was assessed using the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) and the Head and Neck QoL (HNQoL) instrument. RESULTS: Of the 570 eligible respondents, the presence of a feeding tube had the most negative impact on QoL, with significant decrements in 6 of the 8 SF-36 scales and all 4 HNQoL scales (P<.01). In descending order of severity, medical comorbid conditions, presence of a tracheotomy tube, chemotherapy, and neck dissection were also associated with significant (P<.05) decrements in QoL domains. Patients who took the survey more than 1 year after diagnosis had improved QoL in 7 of 12 domains. Hospital site, age, education level, sex, race, and marital status were also significant predictors of QoL. CONCLUSION: There are at least 13 demographic and clinical characteristics that are significant predictors of QoL in patients with head and neck cancer, which should be considered when treating patients and conducting QoL studies in the future.

The lived experience of survivors of prolonged mechanical ventilation: a phenomenological study.

BACKGROUND: Successful liberation from prolonged mechanical ventilation (PMV) is a challenging phenomenon. Whereas many physiological factors have been linked to successful PMV liberation, the psychosocial components are not well delineated. OBJECTIVES: This article serves to describe the experience of patients who survived PMV and to identify salient factors that contributed to successful liberation. METHODS: A phenomenological approach was used to explore the lived experience of seven PMV survivors. RESULTS: Six mutually exclusive themes emerged from the participants' descriptions to create a structural description of the lived experience. CONCLUSIONS: Survivors credited their own self-determination and the expertise and care of health care professionals with their ability to be successfully liberated from prolonged mechanical ventilation. Although surviving PMV was described as frightening and traumatic, comfort and resolve were derived from family members, religion, prayer, and angelic encounters. These findings are useful in providing direction for critical care clinical practice and future research.

El paciente traqueotomizado en Atención Primaria

En los últimos años se viene observando que el número de pacientes portadores de cánulas de traqueotomía ha aumentado debido, fundamentalmente, al mayor número de altas hospitalarias de pacientes que por patologías de vía respiratoria, neurológicas y, en menor número, tumorales, han precisado esta técnica quirúrgica en su tratamiento, pasando a control por el médico de cabecera y su equipo de Atención Primaria, ya sea de forma ambulatoria o mediante asistencia domiciliaria.La traqueotomía no entraña más dificultades que el de cualquier estoma, si bien es conocido la repulsa que a veces produce en el paciente y sus familiares. De la misma manera, en los sanitarios poco habituados a su cuidado se produce una sensación de incapacidad para poder resolver los cuidados que precisa el paciente, sobre todo en el ámbito rural.Con estas líneas se intenta revisar los cuidados del paciente traqueotomizado, desterrando ese temor infundado que a veces se aprecia en la Asistencia Primaria, para evitar en lo posible traslados urgentes innecesarios (AU)

Overcoming the top 10 tracheotomy self-care learning barriers.

Multispecialty inpatient units are the norm in today's acute care settings. Since few units have the luxury of seasoned otorhinolaryngology (ORL) nurses, care of the postoperative patient with a tracheotomy, including discharge teaching and planning are left to the generalists. Generalist nurses and new ORL nurses may find themselves experiencing fear and anxiety along with the tracheotomy patients they care for and teach. Experienced ORL nurses are continually challenged to find ways to share their expertise with patients and less experienced nurses in effective ways. This article presents a unique approach to preparing nurses to teach self-tracheotomy care to their patients. Medical-surgical staff nurses attended a 90-minute inservice program presenting actual clinical scenarios of temporarily learning-impaired patients with tracheotomies, and were asked to role play effective interventions. The program content is designed to address the reluctance of inexperienced, busy nurses to confront learning barriers and motivate patients to accomplish early postoperative involvement in tracheotomy self care. The widespread nature of the challenges faced by nurses and patients regarding tracheotomy care has been confirmed by discussions with colleagues on a national level. It has been confirmed further by the first author's clinical experiences in a wide variety of health care settings. Recommended nursing actions and responses to learning barriers presented here are based on expert opinion and clinical experience.

[Quality of life stress in patients with larger tumors of the mouth. A descriptive study of psychosocial effects of illness and primary surgery therapy in 3 parts--1: Quantity and quality of life]. / Lebensqualitätsbelastung von Patienten mit grossen Tumoren der Mundhöhle. Eine deskriptive Studie der psychosozialen Auswirkungen von Krankheit und primär chirurgischer Therapie in 3 Teilen--Teil 1: Quantität und Qualität des Lebens.

Up to about 40 years ago, the therapy of large tumors of the oral cavity often resulted in severe disfigurement and dysfunctions. Modern resection and reconstruction techniques now enable tumors of this type to be removed in such a way that virtually normal eating and speech functions are restored and traces of the extensive surgery are barely noticeable in many patients. After rehabilitation, most of these patients seem objectively to have a high quality of life, but it is less clear whether their subjective experience is the same. In a three-part empirical study the "limitations of quality of life" (LQL) of 50 patients with large tumors of the oral cavity were investigated at four points of time: preoperatively as well as 1, 4 and 12 months postoperatively. Our self constructed questionnaire for LQL includes 241 questions covering 19 fields of limitation. The results were compared with those of a group of patients after total laryngectomy (n = 34) and a group of patients "without cancer" (n = 40). One year after surgery the limitations of quality of life of patients with large tumors of the oral cavity are still large but seem less so than those of patients after total laryngectomy. However, objectively marginal problems such as a change of body image through a minor disfigurement, slightly indistinct articulation, or a prolonged period of accustomization to dentures are experienced as a severe strain by many patients. The apparent hypersensitivity of many patients to minor discomfort is seen as an effect of the demands made by modern society for fast, subtle adaptive processes. The second part of the study deals with the coping strategies applied by patients, and the third part is focused on a search for variables which could serve as preoperative indicators of the individual ability to bear the burden of illness and therapy.

Quality of life in COPD patients using transtracheal oxygen.

Transtracheal oxygen offers patients with chronic obstructive pulmonary disease many benefits. A qualitative study was conducted to examine patients' perceptions of how the technology affects quality of life. This study has several implications for nurses working in hospital and home settings.

Psychiatric aspects of head and neck surgery. Part I: New surgical techniques and psychiatric consequences.

Individuals who undergo head and neck surgery experience extreme stressors that go beyond those which occur with the usual surgical patient. This paper will review the literature and discuss the psychiatric consequences of otolaryngeal surgery. In addition, new head and neck surgical techniques, which offer special challenges to the patient as well as to the psychiatric consultant, will be examined. Tracheostomy, which occurs as a result of head and neck surgery, is of particular importance with regard to postoperative adaptation and is a significant complication that must be reckoned with.