Efklidis Proimos

Bronchoscopy for foreign body removal in children. A review and analysis of 210 cases

OBJECTIVE A foreign body aspiration in the tracheobronchial tree is a dangerous and common medical emergency in childhood, with serious and potentially lethal consequences. It must be suspected in children with a suggestive history, even though the clinical symptoms or radiographic findings are not pathognomonic for foreign body aspiration. METHODS In this study 210 pediatric cases, with a suggestive history of foreign body aspiration undergoing bronchoscopy in the last 8 years in the department, were reviewed. In all cases bronchoscopy was performed under general anesthesia using a Storz ventilation bronchoscope with distal cold light illumination. RESULTS In 130 patients a foreign body was discovered, in 17 cases pus was aspirated and in 63 cases there were no findings. Seventy-eight (60%) foreign bodies were found in the right main bronchus, 43 (33.1%) in left main bronchus, seven (5.4%) in both bronchi and two (1.5%) were found in the subglottic area. The incidence of bronchoscopy during the last 8 years was 28 procedures per 100000 children population per year in the island of Crete. CONCLUSION More attention should be given to the need for a careful history and the use of radiographs as supplemental information to make the decision to perform a bronchoscopy. The parents, also, should pay attention not to allow children dry fruits and small toys, as well as, teaching their children to avoid any physical or emotional activity while having a full mouth.

Brown tumor of the maxillary sinus in a patient with primary hyperparathyroidism: a case report

IntroductionBrown tumors are rare focal giant-cell lesions that arise as a direct result of the effect of parathyroid hormone on bone tissue in some patients with hyperparathyroidism. Brown tumors can affect the mandible, maxilla, clavicle, ribs, and pelvic bones. Therefore, diagnosis requires a systemic investigation for lesion differentiation.Case presentationWe present a 42-year-old Greek woman, with a rare case of brown tumor of the maxillary sinus due to primary hyperparathyroidism. Primary hyperparathyroidism is caused by a solitary adenoma in 80% of cases and by glandular hyperplasia in 20%.ConclusionsDifferential diagnosis is important for the right treatment choice. It should exclude other giant cell lesions that affect the maxillae.

Multiparametric comparison of cold knife tonsillectomy, radiofrequency excision and thermal welding tonsillectomy in children

OBJECTIVE This is a prospective study evaluating certain intraoperative and postoperative parameters, comparing the relatively new technique of thermal welding tonsillectomy with cold knife tonsillectomy, and radiofrequency excision in pediatric population. METHODS Ninety children aged from 5 through 13 years were enrolled a randomized prospective trial comparing cold knife tonsillectomy, radiofrequency excision, and thermal welding tonsillectomy. Indications included recurrent acute tonsillitis and/or obstructive sleep apnea syndrome. All techniques were compared by means of length of surgery time, blood loss, postoperative bleeding and postoperative pain. RESULTS Sixty-eight patients underwent tonsillectomy for obstructive sleep apnea, whereas 22 children underwent tonsillectomy due to recurrent acute tonsillitis. Median values of all variables tested, length of surgery time, blood loss, postoperative bleeding and postoperative pain, were found to differ significantly among the three surgical techniques (P<0.001). Particularly, a statistically significant higher median duration (P<0.001) and intraoperative blood loss (P<0.001), as well as, a statistically significant lower median pain score in each day tested (P<0.001) of the cold knife group, compared to each one of the other two groups, were found. Tissue welding and radiofrequency groups did not differ significantly in any aspect tested. CONCLUSIONS Both thermal welding and radiofrequency excision techniques have shown comparable results regarding intraoperative blood loss, postoperative hemorrhage, and pain. Compared with cold knife tonsillectomy, welding and radiofrequency excision techniques were associated with less intraoperative blood loss and duration, though cold knife tonsillectomy seems to prevail over the two techniques in terms of the postoperative pain.

Evaluating the Outcome of Phonosurgery: Comparing the Role of VHI and VoiSS Questionnaires in the Greek Language

OBJECTIVES/HYPOTHESIS The objective was to study the role of the Greek version of Voice Handicap Index (VHI) in comparison with Voice Symptom Scale (VoiSS) in terms of measuring voice surgery outcome in patients with benign laryngeal lesions. STUDY DESIGN Nonrandomized prospective. METHODS Forty-six patients operated for benign laryngeal lesions were enrolled in the present study. All patients were assessed according to the European Laryngological Society guidelines. In terms of self-evaluation, patients answered the Greek versions of both VHI and VoiSS, preoperatively and 6 weeks postoperatively, and the results were statistically analyzed. RESULTS The strongest correlation was observed between the functional subscale of VHI and the impairment subscale of VoiSS, as well as, between the emotional subscales of both VHI and VoiSS, pre- and postoperatively. A statistically significant change in subscale and total scores was found. VHI and VoiSS subscales and total scores correlated with the stroboscopic and aerodynamic measurements in a variable manner. Perceptual measurements, as well as shimmer and harmonic-to-noise ratio showed significant correlation with both VHI and VoiSS subscale and total scores postoperatively. CONCLUSION VHI and VoiSS are considered useful tools in evaluating voice surgery outcome, in the Greek language.

Alternaria and Cladosporium calendar of Western Thrace: Relationship with allergic rhinitis symptoms.

Alternaria and Cladosporium are the most important outdoor moulds. The aim of this study was to present fungal spore monitoring data, investigate the relationship of fungal counts with climate conditions, and to explore the clinical significance of Alternaria and Cladosporium species monitoring in allergic rhinitis (AR).

Clinical Application of Subjective Measurements for OSAS Assessment: Predictive Factors of Syndrome Severity

Purpose of the Study: To examine the clinical value of subjective evaluations of obstructive sleep apnea syndrome (OSAS) in correlation with syndrome severity as diagnosed with polysomnography. Procedures: 210 patients with mild to severe OSAS were assessed. Objective evaluation included polysomnography. Subjective assessment included full ENT examination, neck circumference (NC) plus body mass index measurements, Mueller maneuver and Epworth Symptom Scale (ESS). Results: The presence of lateral pharyngeal wall movement, abnormal ESS scoring and male gender can be considered independent risk factors for the prediction of moderate/severe OSAS (p < 0.05). Increased NC can also be considered a clinical risk factor related to male gender and lateral pharyngeal wall movement (p = 0.05). Conclusions: Subjective OSAS assessment, including evaluation of lateral pharyngeal wall movement, ESS scoring and NC measurement can safely predict, mainly in males, OSAS severity, as diagnosed with polysomnography. Message of the Paper: Subjective assessment from the ENT point of view should raise high suspicion towards the early diagnosis of moderate/severe OSAS.

Use of Oximetry to Determine Need for Adenotonsillectomy for Sleep-Disordered Breathing

Abnormal desaturation index is used to identify a subgroup of children with tonsillar hypertrophy and snoring who will benefit from surgery. BrightcoveDefaultPlayer10.1542/6138657589001PEDS-VA_2017-3382 Video Abstract OBJECTIVES: We evaluated the efficacy of adenotonsillectomy (T/A) in children with sleep-disordered breathing (SDB) in a controlled study using oximetry. We hypothesized that children with SDB and abnormal nocturnal oximetry in a community setting will have improved hypoxemia indices after T/A. METHODS: Children with snoring and tonsillar hypertrophy (4–10 years old) who were candidates for T/A were randomly assigned to 2 oximetry sequences (baseline and 3-month follow-up): (1) oximetry immediately before T/A and at the 3-month follow-up, which occurred postoperatively (T/A group); or (2) oximetry at the initial visit and at the end of the usual 3-month waiting period for surgery (control group). Outcomes were (1) proportion of subjects with McGill oximetry score (MOS) >1 at baseline acquiring MOS of 1 at follow-up and (2) proportion of subjects achieving oxygen desaturation (≥3%) of hemoglobin index (ODI3) <2 episodes per hour at follow-up if they had ODI3 ≥3.5 episodes per hour at baseline. RESULTS: One hundred and forty children had quality oximetry tracings. Twelve of 17 (70.6%) children with MOS >1 in the T/A group and 10 of 21 (47.6%) children with MOS >1 in the control group had MOS of 1 at follow-up (P = .14). More subjects in the T/A than in the control group achieved ODI3 <2 episodes per hour at follow-up (14 of 32 [43.8%] vs 2 of 38 [5.3%]; P < .001). Three children with elevated ODI3 were treated to prevent persistently abnormal ODI3 in 1 child at follow-up. CONCLUSIONS: An ODI3 ≥3.5 episodes per hour in nocturnal oximetry is related to increased resolution rate of nocturnal hypoxemia after T/A for SDB compared with no intervention.

TWO RARE CASES OF NEOPLASMS OF THE NOSE AND PARANASAL SINUSES

Purpose: To present the diagnostic approach and treatment of two rare neoplasms, hemangiopericytoma and hemangioleiomyoma, treated in the ENT Dept. of Chania General Hospital. description of the cases: A female, 65 years old, with severe nasal congestion, diplopia and exophthalmos and an 82 years old male with unilateral, recurrent, moderate epistaxis were admitted in the ENT Dept. In both cases assessment included full ENT examination, laboratory tests and imaging with CT and MRI scans. For the first patient, due to extension of the lesion in the right maxillary sinus and orbit, excision biopsy with combined Caldwell-Luc and endoscopic approach was decided. Five months after initial intervention she had local recurrence and distance metastasis and underwent adjuvant chemotherapy. She is on follow up without any indication of expansion of the preexisting disease. For the second patient, specimen from the lesion in the left nostril was sent for histology and he denied any further intervention. The patient is on regular follow up without any change from the initial diagnosis. Conclusion: While clinical examination raises the suspicion, diagnosis is confirmed by histology, and extent of disease is evaluated with CT-MRI scans. Imaging should precede biopsy because of high vascularity of these tumors. Appropriate treatment is extensive removal of the lesion. keywords: hemangiopericytoma, hemangioleiomyoma, nose-paranasal sinuses.

The botulinum toxin in the treatment of autonomic nervous system dysfunctions and headache

performed via an endonasal microscopic-endoscopic approach. Results: A significant improvement of vision after surgical decompression was obtained in 4 patients: The visual acuity of 2 patients increased from recognition of hand motion to 20/400 and to recognition of count fingers, respectively. Another patient experienced an increase of visual acuity from preoperative light perception to postoperative 20/25. The fourth patient improved from 20/500 to 20/200. After surgery, the fifth patient had no change of his preoperative state of complete amaurosis. No specific surgical complications were seen in any of these 5 cases. Conclusion: The surgical decompression of the optic nerve after a time interval of 1 to 5 days has shown a reasonably improved prognosis for reconstitution of vision. Also the surgical intervention is necessary to be performed as early as possible. According to our results, a late decompression is still beneficial.