To examine the value of a subjective numerical rating scale (NRS) in the initial evaluation of patients suspected of suffering from unilateral sudden sensorineural hearing loss (SSNHL) until a formal audiogram is available.Prospective noncontrolled clinical study.Thirty-one consecutive patients referred to the emergency department due to suspected unilateral SSNHL and with no other aural pathology by history or physical examination were enrolled. Patients were asked to characterize the severity of their hearing loss using an NRS of 1 (normal hearing) to 6 (complete deafness). SSNHL was defined as an SNHL of at least 30 dB over 3 consecutive frequencies that occurred in 3 days or less. A formal audiogram was obtained subsequently as soon as available.Twenty-four patients were treated with steroids and met the audiometric criteria of SSNHL. All scored their NRS as 3 or more. None of the 7 patients whose NRS grades were ≤2.5 met the criteria for SSNHL. Two patients were treated with steroids although their hearing did not meet the audiometric criteria for SSNHL as the hearing loss was limited to 2 consecutive frequencies. The NRS score for both was <3.In addition to the patient's history and physical examination, a NRS can be a useful tool in the preliminary assessment of patients suspected of having SSNHL until audiometry becomes available. In the scale of 1-6, an NRS score of 3 or more reliably predicts the need to treat the patient with steroids according to the accepted criteria.
Juvenile nasopharyngeal angiofibroma (JNA) is a benign, highly vascular tumor which occurs predominantly in adolescent males. Despite histologically benign features, up to 20% of patients may have skull base or intracranial involvement upon diagnosis. We report the surgical technique and outcome in seven patients with intracranial extension.
Objective: Decannulation of patients with tracheotomy usually requires decrease in tracheostomy tube size, capping for 24-48 hours and observation after tube removal.Delay in decannulation may increase cardiopulmonary load, prolong hospitalization and cause patient distress.We propose a one-stage procedure in an intensive care unit (ICU) setting for patients undergoing head and neck surgeries and temporary tracheotomy.Study Design and Setting: Patients undergoing resection of head and neck tumors involving the oral cavity or oropharynx in a tertiary cancer center were prospectively studied.Following clinical and laboratory assessments, the tracheostomy tube was removed under cardiopulmonary monitoring in the ICU.Results: All 24 study patients underwent successful decannulation and were discharged 24 hours later.Follow-up time was 5 months.None of them required reintubation or recannulation. Conclusion:A one-stage decannulation is feasible and safe for patients undergoing resection of head and neck tumors involving the oral cavity or oropharynx.This procedure may lessen hospitalization time and reduce patient's distress.
Mycoplasma pneumoniae is one of the most common pathogens that causes community-acquired respiratory tract infection. Outbreaks are well known, and all age groups are susceptible. An outbreak in an army training unit afforded an opportunity to identify possible risk factors for morbidity.An outbreak of respiratory illness that occurred in a unit comprising 91 trainees was investigated and analyzed as a cohort study. M. pneumoniae infection was suspected on clinical grounds and was confirmed by polymerase chain reaction, culture, and serologic testing. Data regarding medical history, symptoms, signs, and laboratory tests were collected.During a period of 12 days, 41 soldiers (45.1%) had respiratory illnesses, of which 10 (11.0%) were pneumonia. Comparison of symptomatic and asymptomatic individuals revealed that smoking was associated with higher rates of disease (risk ratio, 2.1; 95% confidence interval [CI], 1.3-3.2; P<.005) and seroconversion (risk ratio, 2; 95% CI, 1.2-3.4; P=.03). In multivariate analysis, both lower acute immunoglobulin G values (adjusted odds ratio, 7.8; 95% CI, 1.4-42.5; P=.018) and smoking (adjusted odds ratio, 5.6; 95% CI, 1.5-20.4; P=.01) were associated with symptomatic infection; stratification according to smoking status revealed that immunoglobulin G levels among nonsmokers were protective. Patients who had pneumonia had lower lymphocyte counts (1400+/-258 vs. 2000+/-465 cells/microL; P=.001).Smoking and lower preexisting immunoglobulin G levels were strongly associated with M. pneumoniae respiratory infection. These findings emphasize the importance of immunity and cessation of smoking for the prevention of disease. The high attack rate emphasizes the extent of infection transmission among healthy persons living in close contact.
Purpose: Juvenile nasopharyngeal angiofibroma (JNA) is a benign, highly vascular tumor which occurs predominantly in adolescent males. Despite histologically benign features, up to 20% of patients may have skull base invasion or involvement of vital intracranial structures upon diagnosis. We report the surgical technique and outcome in seven patients with intracranial extension of JNA who underwent complete resection through a combined subcranial or a temporal-infratemporal approach.
Ecthyma is an invasive, ulcerated skin infection. Four ecthyma outbreaks occurred in different infantry units in the Israeli Defense Force from October 2004 through February 2005. Morbidity attack rates in the first 3 outbreaks were 89% (49 of 55 soldiers), 73% (32 of 44), and 82% (37 of 45). In the fourth outbreak, in which early intervention (antimicrobial treatment and improvement of hygiene) was applied, the attack rate was 25% (10 of 40 soldiers). In the first outbreak cluster, 4 soldiers experienced poststreptococcal glomerulonephritis, and 5 cases of systemic sequelae were recorded (1 case of severe septic shock, 3 cases of pneumonia, and 1 case of septic olecranon bursitis).Streptococcus pyogenes and Staphylococcus aureus were isolated from ecthyma sores, oropharynx, and anterior nares of affected and unaffected soldiers involved in all 4 outbreaks.Although the S. aureus isolates had different genomic profiles, >90% of S. pyogenes isolates were identified as belonging to a single clone, emm type 81, T type 8. Epidemiological investigation revealed that the hygiene levels of the soldiers and their living conditions were probably the most important cause for the difference in attack rates, wound severity, and systemic sequelae found between and within the units.Our study demonstrates the possible ramifications of the combination of a virulent and highly infective S. pyogenes strain and poor living conditions, and it emphasizes the importance of early intervention in such conditions.
Objective: Decannulation of patients with tracheotomy usually requires decrease in tracheostomy tube size, capping for 24-48 hours and observation after tube removal. Delay in decannulation may increase cardiopulmonary load, prolong hospitalization and cause patient distress. We propose a one-stage procedure in an intensive care unit (ICU) setting for patients undergoing head and neck surgeries and temporary tracheotomy. Study Design and Setting: Patients undergoing resection of head and neck tumors involving the oral cavity or oropharynx in a tertiary cancer center were prospectively studied. Following clinical and laboratory assessments, the tracheostomy tube was removed under cardiopulmonary monitoring in the ICU. Results: All 24 study patients underwent successful decannulation and were discharged 24 hours later. Follow-up time was 5 months. None of them required reintubation or recannulation. Conclusion: A one-stage decannulation is feasible and safe for patients undergoing resection of head and neck tumors involving the oral cavity or oropharynx. This procedure may lessen hospitalization time and reduce patient's distress.
Introduction Skull base lesions in children and adolescents are rare, and comprise only 5.6% of all skull base surgery. Anterior skull base lesions dominate, averaging slightly more than 50% of the cases. Until recently, surgery of the anterior skull base was dominated by open procedures and endoscopic skull base surgery was reserved for benign pathologies. Endoscopic skull base surgery is gradually gaining popularity. In spite of that, open skull base surgery is still considered the “gold standard” for the treatment of anterior skull base lesions, and it is the preferred approach in selected cases. Objective This article reviews current concepts and open approaches to the anterior skull base in children in the era of endoscopic surgery. Materials and Methods Comprehensive literature review. Results Extensive intracranial–intradural invasion, extensive orbital invasion, encasement of the optic nerve or the internal carotid artery, lateral supraorbital dural involvement and involvement of the anterior table of the frontal sinus or lateral portion of the frontal sinus precludes endoscopic surgery, and mandates open skull base surgery. The open approaches which are used most frequently for surgical resection of anterior skull base tumors are the transfacial/transmaxillary, subcranial, and subfrontal approaches. Reconstruction of anterior skull base defects is discussed in a separate article in this supplement. Discussion Although endoscopic skull base surgery in children is gaining popularity in developed countries, in many cases open surgery is still required. In addition, in developing countries, which accounts for more than 80% of the world's population, limited access to expensive equipment precludes the use of endoscopic surgery. Several open surgical approaches are still employed to resect anterior skull base lesions in the pediatric population. With this large armamentarium of surgical approaches, tailoring the most suitable approach to a specific lesion in regard to its nature, location, and extent is of utmost importance.
