Browsing by Subject "Otorhinolaryngology"

Now showing 1 - 16 of 16
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    A biomechanical study of the movements of the arytenoid cartilage
    (1981) Sellars, Ione; Keen, E N
    The joint between the arytenoid cartilage and the cricoid cartilage is one of the smallest in the body. Its existence has been known since, if not before, the time of Galen (130-201 A.D.). However, little anatomical study has been carried out on this synovial joint and publications based on research into its exact anatomy and function are few. The results of these studies have been rarely questioned or scientifically re-examined, with the consequence that authoritative anatomical texts have perpetuated unconfirmed ideas of the behaviour of the cricoarytenoid joint. The purpose of this thesis is to present in detail the results of research into the anatomy and the functions of the cricoarytenoid joint and of the muscles that act upon it. This research began in 1977 with the dissection of 45 cadaver larynges. In this initial study the most striking anatomical finding was the identification of the so-called "posterior" cricoarytenoid ligament, of which inadequate and often incorrect detail has been presented in standard anatomy texts. Another surprising finding of this work was the variability of the shape and positions of the two cricoid facets. In 1978 these findings were published in detail (Sellars and Keen). An attempt to understand the accepted muscular control of the cricoarytenoid joint led to further research. This was carried out by the dissection of a further 23 larynges, with special care to examine the exact origin, direction and insertion of each muscle concerned. Six of these larynges, which had been surgically excised, were also stimulated electrically immediately after excision and the resultant arytenoid cartilage movements were recorded and analysed. The findings of this study were published in 1978 (Sellars) and these articles (Sellars and Keen, 1978; Sellars, 1978) are referred to in "Gray's Anatomy" and in Grant's "Method of Anatomy" (Sellars and Keen, 1978). Further examination of the reactions of these intrinsic laryngeal muscles to electrical stimulation has since been done on three additional fresh operative specimens. This additional work on laryngeal muscle action suggests that the explanation of specific intrinsic laryngeal muscle actions made in the earlier publication (Sellars, 1978) had been oversimplified. The main experimental work, on which this thesis is based, attempts to clarify and interpret the highly complex synchronized muscle actions that occur at the cricoarytenoid joint. Relevant facts found in both recent and old publications relating to this subject are presented and discussed. Before the review of literature is presented the embryology and basic anatomy of the larynx are described.
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    Comparing the efficiency of beclomethasone, fluticasone and mometasone nasal sprays in a Samter's population
    (2015) Monteiro, Pedro Vilas Boas; Lubbe, Darlene
    Statement of problem: Topical corticosteroids nasal sprays remain first line of treatment for patients with chronic rhinosinusitis (with or without nasal polyps). The main aim of treatment is to improve nasal symptoms by reducing or eliminating the nasal polyps and preventing polyp recurrence post-operatively. Our aims were to determine if the type of corticosteroid nasal spray used post operatively influences polyp recurrence rate and if there were any subsequent economic implications as we only have beclomethasone available for prescription in our state hospital. Methods: Retrospective case note review of all Samter's patients who underwent fronto-spheno-ethmoidectomy by a single surgeon (2000 – 2014). Results: 58 patients were included in our study, divided into 3 study groups. When compared to patients using beclomethasone; patients using fluticasone had an 80% reduced risk of polyp recurrence and patients using mometasone a 90% reduced risk. This rose to 88% and 96% respectively when adjusted for age. Conclusion: Fluticasone and mometasone are both statistically significantly more effective at reducing polyp recurrence than beclomethasone in our population group. Mometasone appeared more effective than fluticasone, but this difference was not statistically significant.
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    Development and evaluation of a free-field voice test for potential use as a community screening tool for hearing impairment in children
    (1999) Omoding, Sammy S; Prescott, C A J; Ogilvy, Dale
    Early identification of hearing impairment in children is essential to avoid potentially disabling effects of hearing loss or deafness. This necessitates effective screening measures appropriate to the community in question. Current methods used in South Africa, especially for pre-school and school going children have resulted in poor coverage as they are designed for the more developed countries. There is thus a need to devise a screening method that is appropriate to our local conditions. In this study, a free-field live voice test was developed based on three levels: whisper, conversational and loud. This was evaluated against pure tone audiometry for sensitivity, specificity, cost and ease of application in two studies: hospital and school- based. A total of 394 children were tested; 189 in hospital-based study and 205 in school based study. 378 of the total were eligible for analysis. In the hospital-based study, the results of 177 children were analysed. The age range was 3 - 12 years with a mean of 5.8 years. The sensitivity (ability of the test to detect hearing impairment) was 80.0%; and the specificity (ability to identify children with normal hearing) was 95.0%. In the school-based study, done after modification and standardisation of the test set, the sensitivity and specificity were 83.3% and 97.8% respectively. Age range was 3 - 8 years with 79% being 4- 6 years. In both studies, the voice test was simpler to perform, easily understood and acceptable to the children and the testers; and considerably cheaper as the only equipment required was picture/toy set. The main limitation was non-standardisation of the test set. This was rectified in the school-based study. The drawbacks noted were the inability of the voice test to detect unilateral hearing loss/deafness and high frequency hearing loss. The voice test generally correlated well with pure tone audiometry and could be used as alternative for screening for hearing impairment in the community especially for pre-school and school going children. However, it is recommended to repeat the study in actual community settings using Community Health Care Workers as the testers. This would also determine the reliability of the voice test, as this cannot be reliably established at this stage.
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    Do proton pump inhibitors reduce the incidence of pharyngocutaneous fistulae following total laryngectomy?
    (2013) Stephenson, Katherine Anna; Fagan, Johan
    Pharyngocutaneous fistula is a common complication of total laryngectomy. We hypothesised that perioperative proton pump inhibitor (PPI) treatment could reduce the incidence of pharyngocutaneous fistulae. This prospective placebo-controlled double-blind randomised controlled trial compared PPI treatment (14 days enteral omeprazole) with a placebo in patients undergoing primary total laryngectomy. The incidence of pharyngocutaneous fistula was recorded.
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    The effect of cloth stoma covers on the tracheal climate of laryngectomised patients
    (2014) Quail, Gavin; Raynham, J J; Fagan, Johan
    Includes summary. Includes bibliographical references.
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    The effect of Cloth Stoma Covers on the tracheal climate of laryngectomised patients
    (2014) Quail , Gavin Sean
    Patients that have undergone a laryngectomy lose the normal heat-moisture-exchange functions of the nose and upper airways. Breathing unconditioned air can cause irritation of the tracheal and bronchial mucosa and lead to chest complaints such as irritating coughing and excessive mucus production and mucus plugs. Disposable HME's that cover the tracheostoma and are stuck to the skin with adhesives are believed to improve the condition of inspired air for laryngectomy patients. HME's work by accumulating heat and moisture during exhalation and reciprocally warming and humidifying in spired air. Due to the cost of HMEs they are not affordable to the general population in South Africa and many other countries. Stoma Covers are simple devices made of a single fabric or combinations of fabrics that are fastened around the neck with the cloth covering the tracheostoma. They are relatively inexpensive to manufacture and can be washed and re-used. No research has been conducted to date regarding the effect of using simple Stoma Covers to improve the tracheal climate in laryngectomy patients.
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    Endoscopic Resection and Post-Operative Brachytherapy in the Treatment of Sinonasal Melanoma
    (2019) Alhadad, Abdulrauf I; Lubbe, Darlene; Lubbe, Darlene
    Background: Sino-Nasal Melanomas (SNM) are rare, aggressive tumours often associated with a poor prognosis due to advanced stage disease at presentation. Mean 5-year survival is 0-46%. Various treatment modalities are used in the management of SNM. Surgery is regarded as the primary treatment modality, but therapy remains controversial. Complete resection is a surgical challenge and it is often impossible to achieve adequate margins due to the fact that tumour often abuts vital anatomical structures. Incomplete resection has been shown to be a predictor of poor survival. Harris et al. (2014) were the first to report on the use of post-operative brachytherapy in an attempt to prevent local recurrence after endoscopic resection of SNM. Methods: A retrospective analysis of all patients undergoing endoscopic resection of SNMs and receiving adjuvant brachytherapy in a single surgeon’s practice between August 2004 and May 2014 was carried out. Outcome measures included local control rate and 5-year overall survival estimated by Kaplan-Meier analysis. The incidence of regional and distal recurrence (metastases) was calculated Results: Five cases of sinonasal melanoma (3 males 2, females) were managed with endoscopic resection and adjuvant brachytherapy. Patients were followed up for a median duration of 61 months (32-154 months) following adjuvant Brachytherapy. Local control was achieved in four out of five patients (80%). Three out of five patients developed distant metastasis. Median time to metastasis was 54 months. One patient received immunotherapy after diagnosis of distant metastasis (BRAF positive). Three out of five patients (60%) died from the complications of distant metastases of sinonasal melanoma. Median survival time following adjuvant Brachytherapy was 61 months (32-154 months). Five-year survival rate was 40% (95% CI 5.2% - 75.3%). Conclusion: This is the only case series describing the use of brachytherapy following endoscopic resection of sinonasal melanoma. Our case series, albeit small, describes a local control rate and 5-year survival comparable with the best reported in the literature. Adjuvant brachytherapy represents a novel approach and potentially a useful addition to the adjuvant therapy armamentarium. The advantages of brachytherapy include a favourable side-effect profile and a shorter duration of treatment, while delivering a dose of radiation similar to that of Conventional Radiotherapy. Further studies are necessary to define the role of brachytherapy in sinonasal melanoma.
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    Hearing loss in the developing world : evaluating the i-Phone mobile device as a screening tool
    (2014) Peer, Shazia
    Background: Hearing loss is a global health burden affecting 360 million people. The highest prevalence is in the Developing World where hearing screening programmes are scarce, and failure to address growing high-risk populations will result in new deaf communities. In resource stretched communities such as these, new strategies to alleviate this burden are necessary. Advances in technology have led to innovative mobile digital devices like smartphones and tablets with the potential to test hearing through audiometric applications. Given the recent upsurge of mobile technology in Africa, it is befitting to determine whether the implementation of science can translate to health service delivery. Objectives: To validate the Apple iPhone mobile device using the uHearâ„¢ application "app" as a possible hearing screening tool in the Developing World.
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    Incidence of aminoglycoside-induced hearing loss in HIV positive and HIV negative multidrug-resistant tuberculosis patients
    (2011) Harris, Tashneem
    Aims of the study: To document the incidence and severity of aminoglycoside-induced ototoxicity at Brooklyn Chest Hospital; To determine the prevalence of the 6 known aminoglycoside-induced deafness mutations in the MT-RNR1 gene (A1555G, C1494T, T1095C, T1291C, A827G and 961 indel C) in a cohort of MDR-TB patients; To determine whether HIV positive MDR-TB patients are more likely to develop aminoglycoside-induced hearing loss than HIV negative MDR-TB patients; To provide clinical guidelines to the medical fraternity on the use of aminoglycoside antibiotics with regard to the side-effect of ototoxicity.
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    Incidence of atrophic rhinitis after endoscopic sinonasal surgery : a retrospective review
    (2014) Kamedien,Mogammad Sauliegh; Lubbe, Darlene
    Sinonasal tumours have been resected endoscopically at Groote Schuur Hospital Cape Town South Africa since 2003. Surgery, although seen as minimally invasive because no external incisions are visible, is often very aggressive and destructive to the nasal structures. The removal of the nasal turbinates has always been seen as sacrilege due to the risk of developing atrophic rhinitis. If the theory regarding developing atrophic rhinitis after a simple turbinectomy stands true, one would expect a high incidence of atrophic rhinitis after radical resection of the sinonasal structures. This has not been our experience. METHODS: The study population includes a retrospective case review of all patients that had endoscopic sinonasal tumour resection by the same surgeon between 2006 and 2010. All patients were assessed for symptoms and signs suggestive of atrophic rhinitis up to two years post resection. RESULTS: 51 patients (34M: 17F) were included in the study. Patients with residual or recurrent tumour (n=19) and patients who had received adjuvant radiotherapy (n=17) had a statistically significant chance of developing symptoms and signs suggestive of atrophic rhinitis over time. Variables such as age, gender, extent of surgery, bilateral disease, benign or malignant tumour, were not statistically significant in the development of symptoms and signs suggestive of atrophic rhinitis over time. CONCLUSIONS: Atrophic rhinitis is not more common in patients who undergo endoscopic sinonasal surgery without adjuvant therapy. However, patients with residual tumour (after debulking surgery) or recurrent tumour and those who had received adjuvant radiotherapy had a statistically significant chance of developing symptoms and signs suggestive of atrophic rhinitis over time. Keywords: atrophic rhinitis, endoscopic resection, turbinectomy, medial maxillectomy, sinonasal tumours.
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    Perceived disability in children and adults with single sided deafness at two tertiary institutions
    (2021) Elfallah, Balgeis; Harris, Tashneem
    Background: Single-sided deafness is defined as a severe-to-profound hearing loss in one ear and normal or near-normal hearing in the other ear. The handicap experienced by patients with bilateral sensorineural hearing loss is well known, but the consequences of single-sided deafness are often underestimated based on the assumption that a person with normal hearing in the contralateral ear is not likely to face a major handicap. Objectives: To determine the handicap level in patients with single-sided deafness, and compare the handicap between employed and unemployed patients. Also, to investigate the relationship between perceived disability and noise in the workplace. The effect of age and duration of hearing loss on the perceived disability of single-sided deafness was also examined. Methods: Two validated questionnaires (1) Speech, Spatial and Qualities of Hearing Scale (SSQ12); and (2) Hearing Handicap Inventory for adults (HHIA) were handed to participants with SSD. This research was conducted in two tertiary hospitals in Cape Town, namely, Groote Schuur Hospital and Red Cross War Memorial Children's Hospital, over the period from November 2018 to August 2020. Results: Fifty-four participants were included in the study, 44 adults and 10 children. Employing the HHIA questionnaire, the results show that 39% of adult participants have a significant handicap compared to 32% who have a moderate handicap and 30% who have no handicap. Also, there was no significant difference in the total handicap scores between the employed and unemployed groups, and the presence of noise in the workplace did not influence the total handicap score in the employed group. There was no influence on age or duration of hearing loss on the total handicap score. The mean of the responses in the SSQ12 questionnaire was between 3.42 and 7; thus, some participants experience major hearing difficulties, while others have minor difficulties. Most of the participants are struggling to follow a conversation with background noise and have difficulty localizing sounds. They also struggle to identify the sound distance. They report increased effort when listening to someone or something. Conclusions: A majority of the patients with single-sided deafness in our population either have a severe or a mild-moderate handicap. A good assessment of the individual's degree of handicap is required to adequately counsel the patient and assist in the decision regarding treatment options.
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    Perioperative cell salvage blood transfusions in endonasal angiofibroma surgery at Groote Schuur Hospital
    (2015) Wasl, Hisham; Lubbe, Darlene
    Surgical approaches for many tumours are often limited by blood loss, exposure and risk to vital anatomical structures; therefore, the standard of care for certain skull base tumours has become endoscopic transnasal resection. Other surgical disciplines often use cell salvage techniques, but review of the otolaryngology literature reveals very few case reports. General surgery procedures are often carried out in a contaminated field and concerns have been raised about its safety. This study investigates the value and safety of salvage-type autologous blood transfusion during the endoscopic resection of juvenile nasopharyngeal angiofibromas (JNA). Methods: Because JNA is a rare vascular nasal tumour, the study extended over a 3-year period to obtain adequate patient numbers. All patients undergoing endoscopic resection during this period were included in the population sample. Ten patients with JNA were identified and underwent embolization prior to endoscopic resection. In all cases the intraoperative blood salvage apparatus was used. Close post-operative monitoring was performed.
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    Radiological differences between HIV-positive and HIV-negative children with cholesteatoma
    (2017) Mc Guire, Jessica Kate; Harris, Tashneem; Fagan, Johannes J
    Introduction: HIV-positive children are possibly more prone to developing cholesteatoma. Chronic inflammation of the middle ear cleft may be more common in patients with HIV and this may predispose HIV-positive children to developing cholesteatoma. There are no studies that describe the radiological morphology of the middle ear cleft in HIV-positive compared to HIV-negative children with cholesteatoma. Aim: Compare the radiological differences of the middle ear cleft in HIV-positive and HIV-negative children with cholesteatoma. Method A retrospective, cross-sectional, observational analytical review of patients with cholesteatoma at Red Cross War Memorial Children's Hospital over a 6 year period. Results: Forty patients were included in the study, 11 of whom had bilateral cholesteatoma and therefore 51 ears were eligible for our evaluation. HIV-positive patients had smaller (p=0.02) mastoid air cell systems (MACS). Forty percent of HIV-positive patients had sclerotic mastoids, whereas the rate was 3% in HIV-negative ears (p<0.02). Eighty-two percent of the HIV-positive patients had bilateral cholesteatoma compared to 7% of the control group (p<0.02). There was no difference between the 2 groups with regards to aeration of the middle ear cleft, bony erosion of middle ear structures, Eustachian tube obstruction or soft tissue occlusion of the post-nasal space. Conclusion: HIV-positive paediatric patients with cholesteatoma are more likely to have smaller, sclerotic mastoids compared to HIV-negative patients. They are significantly more likely to have bilateral cholesteatoma. This may have implications in terms of surveillance of HIV-positive children, as well as, an approach to management, recurrence and follow-up. HIV infection should be flagged as a risk factor for developing cholesteatoma.
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    Sentinel node biopsy for the clinically N₊ & N₀ neck in squamous carcinoma of the head and neck
    (2010) Edkins, Oskar
    The objectives of the study were to determine the accuracy of Sentinel Lymph Node Biopsy (SLNB) in head and neck squamous cell carcinoma (SCC); to determine its role in the approach to the clinically N+ neck in a Developing World setting; and its accuracy as an indicator of regional lymph node status in the clinically N neck.
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    Tonsillectomy rates in the South African private healthcare sector
    (2018) Douglas-Jones, Paul; Fagan, Johannes J
    Background. Adeno-/tonsillectomy is a commonly performed procedure with internationally standardised and recognised indications. Despite this, there exists considerable international (190 - 850/100 000 people ≤19 years of age) and regional variation in adeno-/tonsillectomy rates. This variation has been ascribed to differences in clinical practice and referral patterns, as well as social and family factors, rather than differences in clinical need or regional morbidity. Objectives. To describe the adeno-/tonsillectomy rate in the South African private healthcare sector, and regional variations thereof. To compare local rates with international rates and to assess current trends in adeno-/tonsillectomy clinical practice. Methods. Analysis of adeno-/tonsillectomy data from January 2012 to December 2013, provided by the largest South African private healthcare funder, accounting for 31% of the medical scheme market. Rates are expressed per 100 000 people ≤19 years of age. Results. The tonsillectomy rate in the South African private healthcare sector was 1888/100 000 people ≤19 years of age in 2012. In 2013, the rate dropped significantly (p-value <0.001) to 1755/100 000. Both are more than double the highest national tonsillectomy rate reported in the literature. There was also considerable regional variation in the adeno-/tonsillectomy rate within South Africa. Otorhinolaryngologists are responsible for approximately 80% of adeno- /tonsillectomies performed in the South African private healthcare sector. Discussion. The South African tonsillectomy rate is very high when compared to international trends and varies regionally within the country. The literature does not support an increased burden of disease as the reason behind this. Rather, it is differences in training and clinical practice of clinicians, as well as social and family factors that have been implicated. Conclusion. The adeno-/tonsillectomy rate in the South African private healthcare sector is substantially higher than international norms. The reasons for this discrepancy require further consideration and investigation.