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The first wave of the SARS-CoV‑2 pandemic required substantial changes in the teaching of medical students, with strict avoidance of direct contact between students and patients. Therefore, the teaching format "bedside teaching" was implemented and conducted as an interactive video-based distance bedside teaching.The objective of this study was to analyze a students' evaluation of this teaching concept in otorhinolaryngology.From an ENT examination room, the situation was transmitted live to the students in a lecture hall, who could interact with the patients through a video connection. Macro-, micro-, and endoscopic images were transmitted into the lecture hall in real time. Evaluation was performed by means of an online questionnaire with 13 questions (Likert scale) as well as by free-text feedback.The response rate was 16.8% (42 of 250 students). Overall, 85.7% had a positive impression, and it was generally considered that the concept was well implemented in light of the special situation. However, students would rather not renounce direct patient contact, even if a certain compensation by video transmission was reported. Overall, this teaching concept was considered as educative, and students could imagine using such a teaching concept more often in the future.This teaching model cannot replace classical bedside teaching, but represents a good alternative-particularly in otorhinolaryngology-if classical bedside teaching is not possible due to the pandemic situation. Aspects of the interactive video-based distance bedside teaching could be implemented into classical teaching concepts in the future.HINTERGRUND: Der Beginn der ersten SARS-CoV-2-Pandemie-Welle im März 2020 erforderte erhebliche Umstellungsmaßnahmen in der medizinischen Lehre mit vollständigem Verzicht auf direkten Kontakt von Studierenden und Patienten. Vor diesem Hintergrund wurde das Lehrformat „Unterricht am Patienten“ (UaP) als interaktiver, videobasierter Distanzunterricht am Patienten etabliert und durchgeführt.Ziel der Studie war die Erfassung der studentischen Beurteilung dieses Lehrkonzeptes im Fach Hals-Nasen-Ohren-Heilkunde.Die Live-Übertragung erfolgte aus einem HNO-Untersuchungsraum zu den im Hörsaal befindlichen Studierenden, welche mit den Patienten interagieren konnten. Makro-, mikro- und endoskopische Untersuchungsbefunde wurden in Echtzeit in den Hörsaal übertragen. Die Evaluation erfolgte anhand eines Online-Fragebogens, welcher 13 geschlossene Fragen (Likert-Skala) beinhaltete, sowie als offenes Feedback in freier Textform.Die Rücklaufquote lag bei 16,8 % (42 von 250 Studierenden). Davon hatten 85,7 % einen positiven Gesamteindruck, und Tenor war, dass das Konzept angesichts der Umstände gut umgesetzt wurde. Dennoch könne auf einen direkten Patientenkontakt eher nicht verzichtet werden, auch wenn eine teilweise Kompensation durch Videoschaltung möglich sei. Insgesamt wurde das Lehrkonzept als lehrreich empfunden, und die Studierenden konnten sich vorstellen, zukünftig häufiger auch ein solches UaP-Lehrkonzept zu nutzen.Dieses Lehrkonzept kann den direkten Patientenkontakt nicht ersetzen, stellt jedoch speziell im HNO-Gebiet eine gute Alternative dar, wenn durch pandemiebedingte Umstände ein „klassischer“ UaP nicht möglich ist. Aspekte des interaktiven, videobasierten Distanzunterrichts am Patienten könnten auch zukünftig in andere Lehrformate integriert werden.

Neck masses are defined as any swelling or enlargement of the structures in between the inferior border of mandible and clavicle and are a common clinical finding that can be encountered in patients of all age groups. There are many potential causes of neck masses so it is important to proceed in affordable, easy available and cost effective diagnostic technique for the proper and early diagnosis of neck masses. As there is very few study data available over clinico-radio-pathological analysis of neck masses, that’s why this study is done. The present study has been carried out on 200 patients with clinically palpable neck masses presenting at ENT department in a tertiary care hospital. Neck swellings were classified into four main headings i.e. Lymph node swelling, Thyroid swelling, Salivary gland swellings and Skin and soft tissue swelling. After taking detailed history followed by complete General, Local and ENT examination, FNAC was done followed by USG. We came to the conclusion that neck masses have very variable presentations, and FNAC is a riskless, easy and fast tool which can be used in forming a diagnosis and appropriate management of neck masses.

ZusammenfassungSteigende normative Ansprüche an Patientensicherheit und Maßnahmen der Qualitätssicherung, aber auch die Problematik multiresistenter Keime und von Erregern mit hohem Ansteckungspotenzial, verstärken die Notwendigkeit hygienisch korrekten Arbeitens.In dieser Studie sollten hygienisch relevante potenzielle Kontaminationsquellen bei der HNO-Untersuchung identifiziert und mögliche Verbesserungsstrategien untersucht werden.Von 5 Untersuchern mit unterschiedlicher Berufserfahrung, deren Handschuhe vor der Untersuchung mit Fluoreszenzlotion benetzt wurden, wurde eine komplette HNO-Untersuchung durchgeführt. Kontaminierungen insbesondere an der Untersuchungseinheit und am Instrumentarium wurden identifiziert. Das potenzielle Risiko einer Übertragung von Erregern auf Folgepatienten wurde mittels eines eigens entwickelten Scores bewertet. Verschiedene Strategien zur Reduzierung identifizierter Kontaminationsmöglichkeiten wurden erarbeitet und gedanklich durchgespielt.Der Score der Untersucher war mit im Mittel 87,4 Punkten (±3,6) sehr hoch. Die Umsetzung von einzelnen Hygienemaßnahmen im Untersuchungsablauf würde zu einer deutlichen Erniedrigung des Scores und damit einer Verbesserung der Hygiene führen: kein Händeschütteln (81,8), zusätzlich Patientenstuhldesinfektion (79,8), Desinfektion wichtiger Flächen (69,8), Bereitstellen von Standardinstrumenten (60,2) oder aller Instrumente (32,2), Desinfektion aller relevanten Flächen und Bereitstellen aller Instrumente (7,4).Die Ergebnisse zeigen sehr deutlich, dass eine HNO-Untersuchung aus Sicht der Hygiene einen komplexen Vorgang darstellt. Für einen verlässlichen Schutz vor möglichen Übertragungsereignissen ist deshalb eine strukturierte Bündelung von Hygienemaßnahmen notwendig.

The frequency of injuries secondary to terrorist attack explosion is globally increasing. Like any other country, our country experienced multiple suicide bombings in recent years. Otologic injuries may be observed after these kinds of attacks. Considering otologic complaints are well known medical results of explosion attacks, routine otologic evaluation in the first examining hospital-even in case of no relevant complaint- is crucial for establishing causal relation in following forensic medicine evaluation. In this study, 33 cases from 6 suicide bomber attacks in 4 different incidents that happened in Turkey were evaluated for otologic injuries. Two out of three patients were not evaluated for otologic injuries in their first hospital visit. It was considered that 8 cases had a loss of hearing and 9 cases had tympanic membrane rupture secondary to the explosion. Complaints such as hearing loss and tinnitus very often after a bomb attack, we saw that 22 of 33 included patients did not have an ear nose, and throat examination at the time of the incident. In this kind of attack, there can be various life-threatening injuries and therefore relatively less important evaluations such as ENT examination can often be overlooked.

Brick kiln workers were evaluated in the field using otorhinolaryngologic and head and neck surgery (ENT) assessments. One-hundred and twenty laborers were assessed. The subjects were divided into three categories according to the work area: before the brick kiln, in the brick kiln, and after the brick kiln. Two evaluations were made, a questionnaire and an ENT examination. If structural changes were observed during the examination, the complication was deemed structural. Seventeen laborers who completed the questionnaire did not participate in the examination. A total of 103 laborers participated in the study: 29 before the brick kiln, 63 in the brick kiln, and 11 after the brick kiln. While general otologic complications were observed in 26 (25.2%) laborers, structural otologic complications were observed in 2 (1.9%). While general nasal complications were observed in 70 (68.0%) laborers, structural nasal complications were observed in 27 (26.2%). Although the general otologic and structural nasal complication rates were higher in the brick kiln group, the general, structural otologic, and nasal complication rates did not reach statistical significance among groups (p > 0.05). Both the general and structural nasal complication rates were significantly higher in laborers who had worked for more than 10 years and did not wear a mask (p

Rhino lithiasis is defined as a solid concretion secondary to the gradual deposition of calcium salt around an exogenous or endogenous central formation in the nasal cavity it is a relatively common condition in developing countries. We report a retrospective study spread over period of 9 years, from January 2012 to December 2020, relating to 16 cases of rhino lithiasis treated in our department. The protocol Included for each patient: an anamnesis, an ENT examination meticulous and systematic scam. Patients consulted for purulent and fetid rhinorrhea associated with nasal obstruction rhino lithiasis affected as many adults as children, the formal sex was affected in 68% of cases un favorable socioeconomic conditions were noted, in 75% of cases diagnostic times ranged from six months to ten years, the examination she the rhinolith as a grayish, hard concretion, unilateral in 15 cases ( 5 cases on the right an on the left ) and bilateral in one case in 2 cases, a foreign body was visualized on endonasal examination, the treatment consisted of an instrumental extraction by natural means (100% of cases) under general Anas the sea in 75% of cases the size of the rhinoliths varied between 5 to 30 mm in diameter. An underlying foreign body was found intraoperatively in 6 cases. Complication was rare (epistaxis: 3 cases), No recurrence was detected. It is always necessary to evoke a rhinolithiasis in front of a chronic unilateral fetid rhinnorhea with or without nasal obstruction on the same side. The nasosinus scanner confirms the diagnosis and helps to prepare the therapeutic strategy alongside the endonasal endocopic examination with the rigid optic which remains a means used both in diagnosis and in therapy.

Diseases of ear, nose, and throat (ENT) are common diseases in the world. The diseases are essential due to morbidities, which affect the physiological functions in the head and neck region. Cerumen impaction is the most common finding disease of ENT in children. The community service was done to find the distribution of ear, nose, and throat examination results of students in Letjen Jamin Ginting Junior High School, Berastagi, especially cerumen impaction which then were treated with cerumen removal. The community service also aimed to increase student's knowledge about ENT disease. The ENT examination was done to 188 students. The students with cerumen impaction were treated with cerumen removal. The students also educated about ENT disease to improve knowledge about ENT disease. Among 188 students, the number of male students was more than female with 98 students (52.1%), where 76 students (40.4%) were 14 years old. 150 students (79.8%) did not have any complaint about their ear, nose, and throat. Ear fullness was a common chief complaint from the students with 15 students (8.0%). Ear disease was a frequent disease with 44 students (47.3%) and cerumen impaction as the most common findings with 43 students (22.9%). In ENT disease education, the evaluation was done with the highest result was get by 8 students with 80% corrected answers. Ear disease had high prevalence with cerumen impaction as the most common findings of ENT examination.

Background. The progressive increase of the number of schoolchildren with adaptation disorders and low level of health in recent years determines the need to assess the characteristics of the psychosomatic status in children and adolescents with various types of somatic pathology, including diseases of ENT organs, accompanied by nasal breathing disorders and hypoxia. It is also necessary to determine the severity of stress in children, for timely prevention and correction of these disorders.Aim: to assess the level of stress in schoolchildren with nasal breathing disorders against the background of nasal diseases and concomitant psychosomatic disorders.Materials and methods. 481 schoolchildren aged 12–17 (boys and girls) were examined. Nasal breathing disorders were assessed by a comprehensive ENT examination, including rhinoscopy, radiography of the sinuses, and olfactometry. The presence and severity of stress were determined by the questionnaire “Social factors and stress”.Results. We found that the high level of stress in children with nasal breathing disorders on the background of ENT pathology is more often associated with the high frequency and severity of psychosomatic symptoms: the presence of dorsalgia, asthenic syndrome, chronic headache and frequent episodes of abdominal pain. Moderately and significantly increased levels of stress associated with the presence of children with hypertension, asthenic syndrome, frequent abdominal pain, frequent pain in the cervical spine, panic disorders.Conclusions. Thus, the presence of certain psychosomatic complaints in children with nasal breathing disorders is directly related to the level of stress, which is important to take into account when planning preventive and corrective measures aimed at increasing the adaptive capacity and stress resistance of children. The studies illustrate the need to assess the psychosomatic status and the level of stress in schoolchildren with nasal breathing disorders taking into account their existing comorbid disorders of the psychosomatic spectrum.

Introduction: Tracheo-esophageal puncture (TEP) with inserting a silicon prosthesis is the gold standard for voice rehabilitation after total laryngectomy (TL). Provox® is an indwelling voice prosthesis which is widely used nowadays. Objective: to evaluate the outcomes of Provox®2 voice prosthesis in vocal rehabilitation after total laryngectomy. Patients and methods: Sixteen patients who had inserted Provox®2 voice prosthesis after total laryngectomy were subjected to history taking, general ENT examination and neck examination. Patients were evaluated for voice outcome two months after the application of the Provox®2 by the maximum phonation time (MPT), Perceptual voice quality analysis by GRBAS scale, Speech intelligibility and Patient’s satisfaction. Results: We found that the production of 100% intelligible voice with a good MPT and quality of voice (assessed by GRBAS scale) using a device with an average life of 375 days would be considered as favorable. Conclusions: The use of Provox®2 voice prosthesis is a safe and satisfactory method for post total laryngectomy voice rehabilitation.

Objectives The authors present the guidelines of the French Society of Otorhinolaryngology (SFORL) for the diagnosis of cervical lymphatic malformation in adults and children. Methods A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members’ individual experience. They were then read over by an editorial group independent of the work group, and finalized in a coordination meeting. Guidelines were graded A, B, C or expert opinion, by decreasing level of evidence. Results The SFORL recommends that complete ENT examination should be performed to identify lesions at high risk of complication or associated with poor prognosis. In case of diagnostic doubt, especially in latero-cervical or oral floor lesions, fine-needle aspiration cytology should be performed before therapeutic decision-making. One or more validated classifications should be used to assess treatment efficacy and monitor progression. The reliability of antenatal diagnosis should be ensured by associating MRI to ultrasound. In antenatal diagnosis, the locoregional extension of the cervical lymphatic malformation should be evaluated accurately for prognosis, and associated malformations should be screened for, to guide treatment options.

Introduction Amidst another wave of COVID-19, the alarming number of cases per day in India has affected the healthcare system and professionals tremendously. As the disease burden continues to increase, ear, nose, and throat (ENT) specialists remain at high risk of exposure to this aerosol borne virus. This requires the creation and regulation of protocols for conducting routine clinical practice, especially by ENT specialists.Objectives To review the available literature and to propose strategies and recommendations for ENT practitioners to conduct their regular practice amidst this pandemic.Data synthesis A systematic review of the available literature on ENT practice during the COVID-19 pandemic was done. Out of the many protocols proposed in various studies, the most practical and feasible ones that could be adopted by practicing ENT doctors/ surgeons in the long run were selected. Adequate precautions and use of high level of personal protective equipment (PPE) is required to be adopted by all practicing ENT doctors. Use of teleconsultation has been promoted as it limits face-to-face exposure. Proper guidelines should be followed for both emergency and elective surgeries. Endoscopy can be used as a safe and useful tool for ENT examination.Conclusion As practicing otorhinolaryngologists, it is of utmost importance that we take all necessary precautions and adopt safety measures in our clinical practice while conducting out patient department (OPD) consultations, operative procedures, and emergency care to protect our patients, ourselves, and other healthcare staff during this time.

To evaluate the association between upper airway obstruction and occlusal anomalies in mouth-breathing children.356 mouth-breathing children were evaluated by ENT physicians and specialists in orthodontics. ENT examination included nasal endoscopy to assess the adenoidal hypertrophy, tonsillar grading and presence of nasal septum deviation. Clinical orthodontic examination was performed to record occlusal variables. Univariate and multivariable logistic regression were performed to study the association between registered variables.221 patients (mean age ± sd = 6.2 ± 2.5 years) met inclusion criteria. 81.4% of children presented malocclusion. A significant association between tonsillar grade 2 and the presence of malocclusion, Class II relation and increased overjet was shown. Tonsillar grade 4 showed a significant association with the presence of malocclusion and increased overjet. Adenoidal hypertrophy and nasal septum deviation did not show any association with occlusal findings.A high frequency of orthodontic problems was seen in mouth-breathing children. Our results suggested that severe tonsillar hypertrophy may determine presence of malocclusion and increased overjet. On the other hand, the association between mild tonsillar hypertrophy and many occlusal anomalies in mouth-breathers suggest an important role of malocclusion in the onset of oral breathing in children.Associazione tra l’ostruzione delle vie aeree superiori e le malocclusioni in bambini con respirazione orale.Valutare l’associazione tra l’ostruzione delle vie aeree superiori e le anomalie occlusali in bambini con respirazione orale.356 pazienti pediatrici con respirazione orale sono stati valutati in un ambulatorio multidisciplinare composto da specialisti in otorinolaringoiatria ed ortognatodonzia. La visita prevedeva valutazione otorinolaringoiatrica con rinofibroscopia e valutazione ortodontica.221 pazienti (età media ± dev st = 6,2 ± 2,5 anni) rispondevano ai criteri di inclusione e sono stati inseriti nel presente studio. L’81,4% dei pazienti presentava una malocclusione. Un’associazione statisticamente significativa è stata evidenziata tra il 2° grado di ipertrofia tonsillare e presenza di malocclusione, malocclusione di Classe II e overjet aumentato. L’ipertrofia tonsillare di 4° grado è risultata associata alla presenza di malocclusione e overjet aumentato. L’ipertrofia adenoidea e la deviazione del setto nasale non sono risultate associate alle variabili occlusali.Nei bambini con respirazione orale è presente un’elevata frequenza di anomalie occlusali. I nostri risultati suggeriscono che una grave ipertrofia tonsillare può determinare la presenza di malocclusione e aumento dell’overjet. D’altra parte, l’associazione tra una ipertrofia tonsillare di grado lieve e diverse anomalie occlusali suggerisce un ruolo importante della malocclusione nell’insorgenza della respirazione orale nei bambini.

Highlights • Tornwald’s cyst is a rare benign disease of the nasopharynx. • The disease has a diverse clinical presentation, with the majority of cases being discovered incidentally. • Nasoendoscopy, imaging studies and pathological examination can be used to confirm the disease. • Endoscopic surgical removal is an excellent safe measure for disease management., Background Tornwaldt cyst (TC) is a relatively rare but benign disease. Although these lesions are asymptomatic and found incidentally during routine ENT examination, the can present with unexplained sinonasal symptoms, such as nasal obstruction, post nasal drip and occipital headache. Aim To study the clinical presentations and outcome of Tornwaldt nasopharyngeal cyst cases diagnosed and managed in our center. Methods Patients with symptomatic TC who were operated and followed up at our center were selected for this study. Results 3 patients with a diagnosis of TC by naso-endoscopy, CT and MRI were included in this study. All patients were males, with age ranging from 54 to 86 years. A trans-nasal endoscopic surgical removal of the cyst was done for all patients with no intra or post-operative complications. All patients were free of symptoms and disease reassurance at follow up. Conclusion Although relatively rare, TC should be suspected in any patient complaining of unexplained sinonasal symptoms. Endoscopic surgical excision is a safe and effective maneuver with no cyst recurrence.

Aim and objective: To evaluate the usefulness of otoacoustic emissions and brainstem evoked response audiometry for assessment of hearing loss in newborn. Materials and Method: Total of 370 healthy newborns were subjected to ENT examination, otoacoustic emissions (OAE) within 3 days to 30 days of birth. All newborn with normal hearing at OAE were not studied further, and for refer cases OAE testing was carried out again at 3rd month of age. The infants who failed the second OAE were subjected to brainstem evoked response audiometry (BERA). All newborn with abnormal BERA were subjected to repeat BERA at 6th month of age. Results: All 370 healthy enrolled babies underwent OAE testing. Of which 200 (54.05%) passed the test and 170 (45.95 %) were referred. All 170 referred babies underwent repeat OAE at age of 3 months. Of which 50 passed the test and 120 were referred again. All these 120 referred cases were subjected to further testing using BERA between the ages 3-4 months. 2 were found to be having profound hearing loss during BERA testing at 3-4 months as well as at 6 months. Conclusion: Profound hearing loss was found in 2 out of 370 enrolled normal newborn. This also means that if only ‘at risk’ babies were screened there is likely chance of missing impaired hearing in newborn without any risk factor. Hence, during hearing assessment it is mandatory to include all newborns irrespective of their status normal or ‘at risk’.

Background In the COVID-19 era physicians have to face with need to perform office procedures maintaining the maximum safety for both the patient and the Doctor himself. The purpose of this paper was to suggest some equipment useful to perform outpatient visits in an ENT setting. Methods A simple modification of the standard headlight used during an ENT visit provides the operator a better face protection without any impairment in vision and comfort. In addition, in order to perform a safer ENT examination, a droplet protective barrier has been adapted to the patient's chair. Results Both the devices have been texted with success during a period of 2 months in our ENT clinic. No cases of contamination have been registered among physicians. Conclusion A simple modification to a device used in the routine ENT activity implemented its protective efficacy with low costs. On the other hand, a more structured tool permitted to obtain a more protected environment during patient examination. Electronic supplementary material The online version of this article (10.1007/s00405-020-06177-3) contains supplementary material, which is available to authorized users.

Background : Neutrophil to lymphocyte ratio (NLR) is one of the inflammatory markers, associated with malignancies progression and metastasis, including head and neck squamous cell carcinoma (HNSCC). Neutrophil to lymphocyte ratio is presenting the activity index of protumor and antitumor. It is easy to perform in daily clinical practice, obtained from blood examination. The aim of this study was to assess the prognostic value of NLR in HNSCC patients, associated with the clinical staging. Methods : This study was an analytic design to explore the relationship between NLR and clinical staging. The sample was collected from pre-treatment HNSCC patients who came to the Head and Neck Oncology Clinic, Dr.Hasan Sadikin General Hospital. The data consisted of disease history, ENT examination, staging determination, and blood sample examination for NLR count. Results : In total, data on 92 HNSCC patients were collected. There was a statistically significant association between NLR with clinical staging in HNSCC (p

The chapter outlines the clinical examination techniques and skills used in assessing patients with ear, nose, and throat (ENT) problems. The basic and advanced equipment required in a clinic or ward setting is detailed. Examination of the ear, nose, throat, and neck is discussed, along with assessment of hearing through tuning fork testing and free field tests of hearing. Full otoneurological assessment of the vertiginous patient is outlined. Special tests of vestibular function are described, along with the use of endoscopes to evaluate the ear, nasal cavity, and larynx.

The diagnosis of hearing loss, especially in the context of newborn hearing screening, is mostly based on auditory brainstem response (ABR). According to the official CCAM nomenclature, ABR consists of recording early auditory evoked potentials to detect thresholds, study conduction times and measure amplitudes (corresponding to codes CDQP006 when performed without general anesthesia, and CDQP014 when performed with general anesthesia). ABR must be rigorously performed and interpreted, always in combination with a complete ENT examination and behavioral audiometry as soon as possible. In order to obtain good quality recordings, ABR must be performed with the infant totally immobile, during a nap. Several protocols can be used according to the child's age in order to obtain good quality sleep. ABR contribute to a precise hearing diagnosis, allowing early management by the first months of life.

Background: The Rinne tuning fork test is used routinely in clinical ENT examination. It is used to assess the person’s hearing acuity. Ideally, 3 tuning forks are used 256, 512 and 1024 Hz. Rinne tuning fork tests can be used to diagnose conductive hearing loss. Aim of our study an attempt is made to find the utility of three different tuning forks (256,512,1024 Hz) for quantification of conductive hearing loss and their accuracy.Methods: A retrospective study with a sample size of 300 was undertaken over 12 months from April 2018 to March 2019 at the out-patient department of ENT of VMKV medical college and hospital, Salem. Patients of both sexes and aged above 10 yrs presenting with conductive hearing loss due to varied etiology were subjected to complete ENT examination including Rinne test with three different tuning forks (256, 512, 1024 Hz).Results: The results of all the tuning forks (256, 512, 1024 Hz) shows that 29 patients were Rinne’s positive to all tuning forks had the air-bone gap range of 15 dB to 19 dB with a mean air-bone gap of 17.63 dB. 83 patients were negative to 256 Hz tuning fork but positive to 512 and 1024 Hz tuning forks had the air-bone gap range of 20 to 29 dB with a mean air-bone gap of 25.46 dB.Conclusions: We conclude that Rinne’s tuning fork test can be used to quantify the degree of conductive hearing loss into mild (20-30 dB), moderate (30-45 dB), and severe (45-60 dB).

Background: Among all forms of tobacco, smokeless tobacco is known to be more carcinogenic than smoking according to various studies. Smokeless tobacco is consumed through various forms in our region like kaddipudi, gutkha, khaini, pan, etc. This study aims at evaluating the different chewing patterns of tobacco and to assess their impact on the oral mucosa.Methods: The patients who attended ENT department with the habit of chewing tobacco were taken into this study after considering the inclusion and exclusion criteria. A detailed questionnaire including various habits and chewing patterns were filled and received from all the subjects, and a comprehensive ENT examination was done for them. Results: In our study, a total of 120 subjects were included who chewed tobacco in various combinations, which we divided into 6 categories; of which 97 users were under category 2 (betel leaf, betel nut, slaked lime and kaddipudi). Among 120 subjects, 35 had malignancy, 51 potentially malignant lesions, 30 early changes and 4 had no changes. There was a statistically significant correlation noted between the duration of chewing for >15 years (p=0.000); frequency of chewing >5 times/day (p=0.004) and also overnight tobacco placement (p=0.027) with the occurrence of potentially malignant lesions and malignancy.Conclusions: In our study, the combination of betel leaf, betel nut, slaked lime with kaddipudi was the most commonly used combined form of smokeless tobacco. The duration, frequency of tobacco chewing, and overnight placement were statistically significant associated with potentially malignant lesions and malignant lesions.

Introduction: The aim of the study was to analyze the profile of patients applying for free preventive examinations within The Forth European Head an Neck Cancer (HNC) Awareness Week in the Department of Otorhynolaryngology in Międzyleski Hospital in Warsaw (ORL MSS). Material and methods: A media campaign was designed to inform HNC risk patients about the opportunity to receive free preventive examinations in ORL MSS. 225 patients were enrolled to the study. Patient age ranged from 26 to 92 (average 63 years). Women accounted for 66% (149) and males 34% (76). Each patient completed a questionnaire assessing risk factors for HNC, including reported symptoms and lifestyle. ENT examination was performed. Some patients were referred for further diagnostics and treatment. Results: The following HNC risk factors connected with lifestyle were found: nicotine in 22%, alcohol in more than once a week in 12%, oral sex in 17%, multiple sexual partners in 10%, rare dental tests in 24%, prosthetic restorations in 45%. The symptom that most often prompted patients to participate in the HNC prevention week was chronic hoarseness (64%) of people, dry mouth (39%), swallowing (37%), nasal obstruction (6%), neck tumour (5%). One per every five patients was referred to further diagnostics: imaging screening 7% (15 persons), fiber optic examination 11% (25 persons), the excision of the lesion 8% (18 persons). 17 patients were referred for further oncological treatment, of which 13 had benign tumors and 4 had malignant tumors. Conclusions: The HNC Awareness Program increases public consciousness and should systematically includes people with risk factors. The introduction of the Program in the ORL Department has made possible to detect and treat cancer in early stages in 7.5% of those who applied for the program. The use of adequate diagnostics and treatment requires, however, adequate financial resources and systemic solutions.

Earache is one of the most common symptom for a patient to visit ENT doctor. It poses difficulty to diagnose the root cause when ENT examination is normal and still the pain persists, hence many a times patients are presumed to have psychosomatic element. While evaluation of earache dental status is often overlooked. 93 such patients of persistent earache with normal ENT examination were evaluated. In 70 of these patients the earache was attributed to either absent, unerupted or obliquely positioned upper or lower last molars which was confirmed by Orthopantomogram.

WOS: 000426234500001, PubMed: 29447793, Objective: To investigate the clinical role of Vitamin D in prognosis of Otitis media with effusion. Methods: This prospective-controlled study was conducted at otolaryngology department in Duzce University, Turkey. The study group comprised children who were diagnosed with Otitis media with effusion between September 2016 and February 2017. Control group was conducted with children underwent circumcision or inguinal hernia repair operations that confirmed with ENT examination they do not have any sign of otitis media. After 3 months of follow-up without any treatment, unresolved cases who were accepted as chronic otitis media with effusion were operated under general anesthesia for ventilation tube application. Study and control groups were assessed depending on the serum 25(OH)Vitamin D levels at the end of 3 months

Total 100 patients of age group 6-65 years old of chronic suppurative otitis media (squamous type-33 and mucosal type-67) visiting ENT OPD with main complain related to ear were selected randomly and thorough ENT examination was done followed by nasal endoscopy and required radiological investigation. 64 patients were found having one or other nasal pathology that might be the culprit for ear disease of the total nasal pathologies maximum cases were of DNS alone or with Allergic rhinitis followed by nasal sinusitis and nasal polyps. The study concludes that nasal diseases are the precipitating factors for chronic suppurative otitis media so every case of CSOM should have through examination of nose and PNS to rule out sinonasal pathology.

Background: Headache is a common symptom. Correct diagnosis of the etiology is the key to successful treatment. Chronic headache are misdiagnosed as sinus headache because of presence of overlapping symptoms leading to unnecessary treatment with no relief to the patient. We decided to undertake this study with the objective of evaluating patients with chronic headache for presence of chronic rhinosinusitis and hence assess the contribution of sinus headache to chronic headache.Methods: The present study was conducted at Adichunchanagiri Institute of Medical Sciences, BG Nagara during the period January 2018 to December 2018. Patients presenting to OPD with chronic headache previously diagnosed as sinus headache were included in the study. A total of 174 patients were studied. All patients underwent detailed history taking, detailed ENT examination, and diagnostic nasal endoscopy. AAOHNS criteria for rhinosinusitis and IHS criteria for migraine and tension type headache were used for diagnosis. Results: We found that only 13% (n=23) cases had chronic rhinosinusitis and hence diagnosed as sinus headache. 53% (n=92) had migraine, 31% (n=54) had tension type headache and 3% (n=5) could not be categorized.Conclusions: Prevalence of sinus headache in our study was found to be 13%. There are high chances of misdiagnosing chronic headache as sinus headache because primary forms of headache can present with nasal symptoms. The AAOHNS criteria for rhinosinusitis and IHS criteria for migraine and tension type headaches are very useful and effective in making an accurate diagnosis.

Summary Introduction: Temporal bone fracture is a common complication of high-energy cranial trauma. Labyrinth involvement is rare, but there is a risk of perilymphatic rupture that is often underes- timated on initial clinical examination due to the predominance of neurological and/or somatic symptoms. Case report: A patient presented with overlooked perilymphatic fistula, decompensated by hyperpressure effort due to poorly adapted management. Discussion: Following a review of the literature on post-traumatic pneumolabyrinth, overall management (from diagnosis to treatment, via prevention advice) was analyzed. A constructive critique of the patient's treatment was thus made. Conclusion: We argue for a systematic management protocol in cranial trauma with temporal bone fracture, comprising ENT examination, millimetric-scale cross-sectional imaging of the fracture site, and standardized counseling to prevent late complications. © 2013 Published by Elsevier Masson SAS.

Introduction For many years the specialists, have been interested in gastroesophageal reflux. The aim of the work is to present our experience in the diagnosis and the treatment of laryngopharyngeal reflux. Material and methods We studied 60 patients (35 women and 25 men) aged 25 to 60 (average age – 43), with symptoms of reflux, hospitalized in ENT Department in the years 2010–2011. In all patients in ENT examination laryngitis were stated. Each patient was treated with 24-hour esophageal pH-impedance during gastrological consultation. In case of confirmed reflux disease proper diet and medication blocking the proton pomp were prescribed for a period of 3 months. The check-up included: patient interview, filling the questionnaire, ENT examination and gastrological consultation. The treatment was continued for the next 3 months with patients with sustaining problems of upper airway. Results Laryngopharyngeal reflux disease was confirmed in all examined patients. After 3 months over 80% patients finished the treatment, the other (13) patients finished their treatment after 6 months. Conclusions ENT and gastrological consultations with 24-hour esophageal pH-impedance help with successful diagnosis and curing the reflux disease.

Objective The aim of this study was to investigate the diagnostic usefulness of combined multichannel intraluminal impedance–pH (MII-pH) monitoring in children with suspected laryngopharyngeal reflux (LPR). Design, setting and participants A prospective study including children in whom, due to LPR suggestive symptoms, MII-pH monitoring was performed at tertiary medical centre from February 2012 to July 2015. Interventions All included children underwent same diagnostic protocol which included examination by single pulmonologist and ENT specialist and underwent 24-hour MII-pH monitoring. Main outcomes Primary outcome was to determine MII-pH characteristics of the children in whom LPR was suspected based on symptoms and ENT examination. Results One hundred and four patients (mean age 8.9 years; range 0.4–17.9 years; male/female 57/47) participated in the study. In children with signs and symptoms suggestive of LPR, MII-pH monitoring found the median incidence of proximal gastro-oesophageal reflux (GER) of 15 (range 0–129), proximal acidic GER of 6.5 (range 0–66) and weakly acidic GER of 5 (range 0–102). There were significant positive correlations between the number of GER (proximal total, acidic and weakly acid) with Reflux Finding Score, Reflux Symptom Index and presence of eosinophils in nasal swabs. The only endoscopy ENT finding which significantly correlated with total proximal GER, acid proximal GER and weakly acidic proximal GER was arytenoid hyperaemia. Conclusion Both acid and non-acid reflux seem to have a significant role in the pathogenesis of LPR.

Objective To classify the adult lingual tonsil according to the macroscopic appearance. Study design Prospective study. Level of evidence Four. Methods Lingual tonsils were classified according to their appearance and relationship to surrounding structures. This was possible following serial views of lingual tonsils. The classification was named ‘Swansea classification for lingual tonsil’, representing the place of origin. The classification was then discussed with fellow clinicians. Independent professional observers graded lingual tonsil pictures. Intra-observer agreements were measured to validate the classification. Results A total of 22 professional observers went through a set of six pictures of three different grades of lingual tonsil. The pictures were then graded for validation. The intra-observer agreement was 0.81, confirming good agreement. Conclusion Swansea classification for lingual tonsil is reliable and reproducible. This classification should be routinely used during ENT examination, enabling accurate documentation and providing opportunities for future research and audit of practice.

The job as a coal-miner exposes to the greatest risk. One of the most dangerous health hazard is a burn/inhalation injury during the methane explosion. The victims undergo physical trauma, effect of high temperature and inhalation of toxic gases and products of incomplete combustion, As a result of inhalation injury both, upper and lower airways are affected. The aim of the study was to analyse the relationship between burn/inhalation injury and quality of voice in affected coal-miners. A group of 23 patients (men) in age from 28 to 59 (mean 38.5) 3 years after burn/inhalation injury participated in this study. The voice evaluation based on ENT examination, videlaryngostroboscopy, acoustic analysis, MPT parameter and GRBAS analysis was performed. The special control group of coal-miners served as a control. On the basis of the subjective evaluation and the objective acoustic analysis, aerodynamic parameter and videlaryngostroboscopy the worse quality of voice in the group of injured coalminers was shown in comparison to the control group. No substantial correlation between the acoustic parameters, MPT parameter and ventilating rates was found.

A prevalence study was carried out in order to look into the etiopathogenic relation of otitis media with effusion (OME) in primary school-age children. The study included ENT examination and a questionnaire that was carried out in 4 randomly selected schools on 1,165 children. 143 of the cases (12.2%) had OME. A significant relation between OME and adenoid vegetation was found (P0.05). As a result, OME is a common disease that can lead to other hard-to-cure health problems and be costly if etiopathogenic factors are not resolved on time.

Summary Objective To assess possibility of olfactory examination in children aged less than 5 years old as well as to determine odors being correctly recognized by Polish children which could be used in screening olfactory examination. Assessment of the olfactory identification impact on body mass index (BMI) Material and Method There were researched 43 Polish children aged 2,9–4,8 years without olfactory disturbances or illnesses influenced on smell in anamnesis and during ENT examination. Olfactory functioning was tested with psychophysical tool, using 21 odors being chosen among stimuli used in the most common olfactory tests. Over 86% of the subjects have completed successfully the olfactory test. Results Six out of 21 tested odors (bubblegum, lemon, cola, mint, toffee, fish) were correctly identified by at least 75% of the children. The odorants could be useful for olfactory screening test in Polish children. Average olfactory test result was 13 odors correctly recognized. There was a correlation between number of odor identifications and age of the subjects. The olfactory test results were not correlated with gender and body mass index. Conclusions The olfactory examination with psychophysical methods can be used in diagnosis of young children nevertheless it requires to be adjusted to age of the subjects. The study presents an example of the olfactory screening test based on odors which are mostly recognized by Polish children aged less than 5-years-old.

The aim of this study was to determine the prevalence of otitis media with effusion (OME) in primary school children in Rize (Eastern Black Sea Region) and the impact of tobacco smoke exposure in the development of OME in primary school children. This study involved a total of 2960 children who appeal for ENT examination to our department at Rize Training and Research Hospital between November 2007 and April 2009. All children were evaluated with regard to OME and exposure to cigarette smoke. Pure tone audiometry and tympanometry tests and pneumatic otoscopy were performed on the children who were diagnosed with OME by otoscopic examination. The association between the children diagnosed as OME and exposure to cigarette smoke was evaluated. The prevalence of OME in this study was 9.86% (292/2960). Exposure to cigarette smoke was a statistically significant factor in development of OME (P

Osteomas are benign tumors of the paranasal sinuses, and are mostly located in the frontal sinus. The evolution of the osteomas is slow and silent. The osteomas are often discovered incidentally on a craniofacial CT scan. Due to the slow growing nature of this tumour, the therapeutic approach is usually “watch and wait”. When symptoms occur, the surgical approach is required. This can be external, endoscopic or combined. The authors report the case of a 55-year-old female patient who was admitted to the hospital with a history of progressive frontal headache for 12 months. The clinical ENT examination and the paralinical exams (nasal endoscopy, computed tomography – head, paranasal sinuses) were suggestive for a left frontal sinus osteoma. The surgical management of the osteoma was a combined approach, including the external Ogston-Luc technique and the endoscopic approach. The postoperative period was uneventful, with no complications, and the drain tube was removed 14 days after surgery.

THE IMPACT OF A UNIVERSITY ENT EMERGENCY CENTRE FOR THE AMBULATORY CARE OF ENT EMERGENCY PATIENTSBACKGROUND: The impact of a German University ENT emergency unit has not been investigated yet. The present study had the aim to define the role of such an ENT emergency unit for the medical supply of ENT emergency cases. Patients' characteristics, diagnostics and therapeutical processes have been analysed. METHODS: In a retrospective study 3 695 emergency cases of the year 2004 have been characterized. RESULTS: Patients referring to the ENT emergency unit are relative young with an average age of 36 years. 72% are coming from the urban area. Two thirds referred themselves without seeing another physician before. The spectrum of diagnoses was broad, mainly similar to the normal spectrum of diseases seen in daily outpatient practice. 17% were emergency cases in narrower sense needing direct help because of real threat. 25% of the patients needed more than a clinical ENT examination. 9% of the cases were admitted to the hospital. DISCUSSION: In a major city without specialised outpatient ENT emergency system patient are attracted regularly to present at the University ENT emergency unit. This means a significant work load for the resident on duty. Most of the patients have ENT diseases treatable with this one and last patient contact. On the other hand, the hospital recruits an important amount of patients for inpatient treatment through the emergency unit.

The objective of this article is to demonstrate the effectiveness of good cooperation between orthodontists and Ear, Nose, and Throat specialists because of the importance of freeing the upper airways from obstruction in order to achieve a good orthodontic result as well as the other side of the coin, the beneficial effect orthodontic treatment can have in stimulating a functional liberation of those airways when no mechanical blockage is present. The article will emphasize how important it is for orthodontists to understand and to be alert to the signs and symptoms that would indicate the need for an ENT evaluation.

Background: Epistaxis is one the common emergencies in Oto-rhino-laryngology. It may occur in any age and in either gender. Cause of epistaxis range from simple self-limiting condition to more sinister malignancy which needs a radical approach. Hence, one should evaluate these patients appropriately and identify the cause to treat them accordingly. The present work was undertaken with the aim of studying the demographic profile of patients with epistaxis, its causes and management.Methods: The present study consisted of 60 patients who came with complaint of epistaxis. The patient’s detailed history was obtained. Detailed systemic examination and ENT examination was performed on patients in the study. Patients were investigated and treated as per the standard hospital protocol. Results: Out of the total 60 cases of epistaxis, 65% were males and 35% were females. Most of our cases were aged more than 50 years (31.7%) with mean age of 38.56 years. Most common etiology of epistaxis in present study was hypertension (20%), followed by acute rhino-sinusitis (15%). Commonest cause in children was deviated nasal septum and acute rhinosinusitis while in young adults, trauma was the common cause. Most common cause in elderly was hypertension. Medical management was done in most of the cases (65%) while anterior and posterior packing was done in 20% and 10% cases respectively. Three cases underwent electro-cauterization of bleeding point.Conclusions: Epistaxis can be seen in anyage. However the etiology of this condition varies with age. Understanding of the etiology helps in better evaluation and treatment of the case.

Brainstem Evoked Response Audiometry (BERA) is an objective and non-invasive method of hearing assessment which detects electrical activity from the inner ear to the inferior colliculus. AIM: To assess the hearing pathway in normal hearing individuals and compare differences associated with gender, age and ear side (left and right). Study Design: A retrospective study. MATERIALS AND METHODS: Sixty normal hearing individuals, aged between 09 and 66 years old, were subjected to clinical ENT examination and audiologic tests. RESULTS: Wave latencies differed significantly between males and females, although there were no differences regarding right or left ear sides. Comparing latency averages regarding age and gender we noticed important differences. By the same token, significant differences were also seen comparing this study with the information present in the handbook of the BERA device used and results published by Fukuda, in another study. CONCLUSION: Knowing the great importance of BERA, it is crucial that each service develops its own standards in order to enhance the accuracy of the electrophysiological diagnosis of the hearing pathway. Potencial Auditivo de Tronco Encefálico (PEATE) é um método objetivo e não-invasivo de avaliação das vias auditivas, que detecta a atividade elétrica desde a orelha interna até o colículo inferior. OBJETIVO: Avaliar as vias auditivas em pacientes normo-ouvintes e comparar diferenças de acordo com sexo, idade e lado da orelha (direita e esquerda). Desenho do estudo: Estudo retrospectivo horizontal. MATERIAL E MÉTODOS: Sessenta pacientes normo-ouvintes, com idades entre 09 e 66 anos, foram submetidos a exame otorrinolaringológico e testes audiológicos. RESULTADOS: A disparidade entre as latências das ondas de homens e mulheres foi estatisticamente significante, entretanto, não mostrou diferença entre os lados das orelhas. Comparando as médias das latências de acordo com idade e sexo também foram detectadas significativas desigualdades. Do mesmo modo, foram diagnosticadas diferenças comparando este estudo com o manual do aparelho utilizado e com os resultados encontrados por Fukuda, em outro estudo. CONCLUSÃO: Frente à grande importância do PEATE, torna-se imprescindível que cada serviço desenvolva sua própria normatização, aumentando a precisão diagnóstica eletrofisiológica das vias auditivas.

PURPOSE: Voice problems are common in occupations with a large voice loading. Clergy are usually classified as professional voice users. The aim of our study was to investigate the prevalence of voice problems in Catholic priests and to identify some of the risk factors for their voice disorders. METHODS: Questionnaires were sent to 600 randomly chosen Catholic parish priests and vicars in Slovenia to collect information on the prevalence and causes of voice disorders, vocal load, vocal habits, and certain diseases influencing voice quality. Data were analyzed for a total of 340 priests and in subgroups of priests with frequent voice disorders, priests without voice disorders, and priests over the age of 64. RESULTS: Overall, 85.6% of the priests reported having voice problems during their career, 15.9 % of them experiencing frequent voice problems. Respiratory-tract infection was the most common cause of the voice problems. The following significant risk factors for frequent voice problems were identified: frequent throat clearing, vocal load during spare time, voice disorders during training and not receiving instruction on correct vocal technique. The priests without voice problems had experienced significantly fewer voice problems during their training and had less frequent throat clearing, less frequent asthma and fewer allergies than the other priests. Being over the age of 64 and teaching more than 10 hours each week were not identified as risk factors for voice disorders. CONCLUSIONS: The prevalence of voice disorders in Catholic priests in Slovenia is high. Respiratory-tract infection is the most common cause of their voice problems. Allergies, frequent throat clearing, not receiving instruction on correct vocal use and vocal hygiene, and a history of voice problems during training were stated as risk factors for voice disorders. In order to decrease the prevalence of voice disorders in priests and in other occupations with a large vocal load, we suggest that an ENT examination before the start of training and the inclusion of information on correct use of the voice and on diseases influencing voice quality should be included as a standard part of the educational process.

Summary Introduction The aim of the study was to evaluate the influence of the selective electrical stimulation of the hearing organ on tinnitus in people with sensorineural hearing loss. Material and methods The study comprised 248 tinnitus patients treated by using electrical stimulation. The material was divided into two groups, regarding the method of stimulation. In group I – 168 people, transtympanal electrical stimulation of the promontory was applied, whereas in group II – 80 people, hydrotransmissive technique was used. ENT examination, audiological and radiological diagnostics, as well as the evaluation of the audiometric parameters of tinnitus was performed. The patients were asked to fill in the questionnaire concerning tinnitus. In 80 patients hydrotransmissive electrical stimulation was conducted using the own prototype device, in 168 patients – transtympanal stimulation, after local anaesthesia with Xylocain gel. Results On the whole, in group of 248 patients, subjective improvement (decrease in the severity of tinnitus) was noticed in 130 people (52.4%), comprising 32 cases (13%) of total relief. In 93 patients (37.5%) tinnitus remained unchanged, and in 25 (10.1%) the deterioration was observed. The comparison of the results of two electrical stimulation methods, showed the superiority of hydrotransmissive one (improvement in 58.75% of patients), however, the number of cases of total relief was greater in the case of transtympanal method (15.5%). Considering subjective evaluation, as well as audiometric (the intensity and the frequency parameters, MML) the hydrotransmissive method appeared to be more effective (improvement in 53.75%) comparing to transtympanal stimulation (improvement in 44.6%). Conclusions On the basis of studies conducted in the Clinic and the long history of the electrical stimulation administration in tinnitus treatment, it can be stated that this method may by applied in cases, in which other therapeutical methods failed.

OBJECTIVE: Besides operation the mandibular advancement splint (MAS) is one of the main options for treatment of snoring. Especially the MAS by Hinz, which exclusively blocks mandibular retrusion, has been established as an effective alternative. The aim of this study is to examine the effectiveness of this MAS and to evaluate the role of obstruction at the level of the tongue base as a successful pretherapeutic predictor by using the sleep nasal endoscopy. SUBJECTS AND METHODS: From August 2001 until August 2006 we have examined over 450 patients with sleep disorders at our hospital. All patients have had an ENT examination, a standardized polysomnography and a sleep nasal endoscopy with therapy simulation. The application of a MAS is indicated if an obstruction at the level of the tongue base is detected and the RDI (respiratory disturbance index) is below 10/h. 10 patients are examined by PSG and partly by sleep nasal endoscopy before and after adjustment of the MAS. The patient group is classified in three velum- (n = 3), isolated tongue base-snorers, five combined tongue base-/velum- and two tongue base-/epiglottis-snorers. RESULTS: The subjective sleep recovery and the snoring-intensity can be improved by the MAS in eight of ten patients. In addition the long-term acceptance of this therapy is very high. CONCLUSIONS: According to our experiences the MAS by Hinz is an effective treatment option for patients with an obstruction level at the tongue base confirmed by sleep nasal endoscopy.