New technology and innovation have allowed development of the new technique of direct phonoplasty under local anaesthetic. This combines the advantages of transcutaneous injection under local anaesthetic and direct injection under general anaesthetic, without their disadvantages.
The aim of this study was to evaluate the patient's experience of transnasal flexible laryngo-oesophagoscopy under local anaesthetic in an out-patient setting. This was a clinical observational study using a patient questionnaire and visual analogue score. Subjects were 50 patients seen in the hospital's ENT outpatient clinic between March and August 2004 in whom transnasal flexible laryngo-oesophagoscopy was performed and who completed pain discomfort questionnaires. Any patient undergoing transnasal flexible laryngo-oesophagoscopy, for either diagnostic or therapeutic purposes, was included in the study. Patients in whom transnasal flexible laryngo-oesophagoscopy was not necessary as part of their investigation or treatment were excluded. Patients completed a questionnaire, providing a simple visual analogue score for discomfort during the procedure. Any operative complications were noted by the surgeon. All patients completed transnasal flexible laryngo-oesophagoscopy, and the upper aerodigestive tract was clearly visualized. The procedure is well tolerated, with mean score of <1 out of 10 for all forms of discomfort. There was a complication rate of 2 per cent (one patient with epistaxis); no other complications occurred. Transnasal flexible laryngo-oesophagoscopy is a new diagnostic and therapeutic technique which is well tolerated by patients. It compares favourably with other flexible endoscopic techniques. This report documents for the first time a detailed description of patients' experience of this technique.
We report a case of laser arytenoidectomy for bilateral abductor palsy of the vocal fold in a patient with Parkinson's disease. Parkinson's disease is known to be a rare cause for bilateral vocal fold palsy and this is the second case reported in the English literature. Majority of the reports to date are in the non-English literature. Tracheostomy has been the classic treatment option offered to these patients. To date no report has been found in the literature about a laser arytenoidectomy being performed in a patient suffering from bilateral vocal fold palsy in Parkinson's disease. We have suggested this option as it improves the quality of life of the individual and avoids the difficulty faced by a Parkinson's patient in managing tracheostomy care due to bradykinesia, rigidity and tremor.
This study investigated the role of sudden sensorineural hearing loss (SSNHL) as a symptom in oral anticoagulant therapy with vitamin K antagonists (Phenprocoumon; Marcumar, Falithrom). Vascular compromise of the cochlea due to thrombosis, embolus, reduced blood flow or vasospasm is one of the four possible pathways that can lead to SSNHL. Oral anticoagulant therapy should prevent thrombosis; if it does not the question arises as to whether the anticoagulation is working, or the wrong hypothesis of vascular compromise has been made. Patients with SSNHL during oral anticoagulant therapy who were admitted to the ENT Department of the University Hospital in Jena from 1998 to 2001 were included. The pure-tone audiograms and the prothrombin time (PT) values before and after the event of the SSNHL were evaluated. The study found 10 patients with SSNHL during oral anticoagulant therapy. Although the audiograms showed some improvement in the majority of cases, three cases showed almost no improvement in hearing. On admission, half of the patients showed a PT-value higher than 30 per cent and in nine cases a PT-value >30 per cent could be demonstrated at least once during testing. It was not possible to demonstrate a relationship between the SSNHL and oral anticoagulation. Vascular compromise cannot be excluded as a cause for sudden hearing loss in patients undergoing oral anticoagulant therapy. It is possible that oral anticoagulants influence the viscosity of the plasma leading to interference with the microcirculation in the inner ear. Further research into this area is currently being conducted.
This is the first reported attempt to use navigation-guided surgery in the soft tissue of the neck. It reveals new opportunities for navigation in the future.
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