Archives of oto-rhino-laryngology

Drug-induced sleep endoscopy (DISE) is a new tool in the work-up of patients with sleep-disordered breathing (SDB). We assessed the impact of DISE on the treatment plan of snoring patients. This is a single institution prospective longitudinal clinical trial. The setting is a private teaching hospital. A consecutive series of 100 snoring patients prospectively underwent a standardised questionnaire, clinical examination, rhinomanometry, allergy skin prick testing, DISE and polysomnography. Management plan before and after DISE evaluation was compared. In 61 patients (excluding 16 patients sent for continuous positive airway pressure, three patients refused sleep endoscopy and 20 were lost to follow-up), we compared the treatment plans. DISE showed single level airway collapse in 13 and multilevel collapse in 48 patients. The site of flutter did not add additional information as compared to the pattern and the location of the collapse. After DISE, the initial management plan changed in 41 % of patients irrespective of the type of initial management plan. The only somewhat accurate initial treatment plan was uvulopalatopharyngoplasty (unchanged in 11/13 patients). Excluding moderate to severe obstructive sleep apnea patients DISE is an indispensable tool in treatment decision in all SDB patients. We suggest to simplify the protocol for DISE reporting.

The majority of studies have shown that the use of functional endoscopic sinus surgery (FESS) leads to symptomatic improvement in 73–98.4 % of patients with chronic rhinosinusitis and nasal polyposis (NP). The aim of the study is to evaluate clinical outcomes and quality of life (QoL) in patients with NP after FESS. The prospective study included 85 consecutive adult patients (≥18 years) with NP who were operated on using FESS after failure of the medicamentous treatment and in certain cases of surgical treatment. QoL was assessed by Short Form-36 Health Survey (SF-36) questionnaire, and the symptom intensity was presented using visual analogue scale (VAS). The objective finding was presented as endoscopic and computerized tomography (CT) score. The intensity of each symptom, the values of symptom scores (major, minor and total), the values of dimension scales and summary scales of the QoL, as well as the values of endoscopic score through three periods of time (pre-surgery, 6 and 12 months after the surgery) were analyzed. Following the FESS, mean intensity values of all individual symptoms and symptom scores were significantly lower and the values of all dimension scales and summary scales of QoL were significantly higher (p < 0.05). There was no statistically significant difference in symptom intensity and QoL after 6 and 12 months of surgical treatment (p > 0.05). Endoscopic score was on average significantly lower after 6 and 12 months of FESS (p < 0.05), but the mean score value after 12 months of operation was significantly higher in relation to that after 6 months of surgery (p < 0.05). Nevertheless, the recurrence of NP was observed in 28 patients (32.9 %) in the follow-up period. In conclusion, FESS in NP patients results in significant improvement of symptom intensity, QoL and endoscopic score. While the intensity of symptoms and QoL showed a tendency to maintain between 6 and 12 months after surgery, endoscopic score showed a tendency of exacerbation in the same period.

Percutaneous endoscopic gastrostomy (PEG) is often the treatment of choice in head and neck cancer (HNC) patients needing long-term nutritional support. Prospective studies on PEG tube placement in an otorhinolaryngologist service are lacking. At our hospital, otolaryngologist—head and neck (ORL-HN) surgeons—have performed PEG insertions for HNC patients since 2008. We prospectively analyzed 127 consecutive HNC patients who received their PEG tubes at the Department of Otorhinolaryngology—head and neck surgery, and evaluated the outcome of PEG tube insertions performed by ORL-HN surgeons. To compare time delays before and after, PEG placement service was transferred from gastrointestinal surgeons to ORL-HN surgeons, and we retrospectively analyzed a separate group of 110 HNC patients who had earlier received PEG tubes at the Department of Gastrointestinal Surgery. ORL-HN surgeons’ success rate in PEG insertion was 97.6%, leading to a final prospective study group of 124 patients. Major complications occurred in four (3.2%): two buried bumper syndromes, one subcutaneous hemorrhage leading to an abscess in the abdominal wall, and one metastasis at the PEG site. The most common minor complication was peristomal granulomatous tissue affecting 23 (18.5%) patients. After the change in practice, median time delay before PEG insertion decreased from 13 to 10 days (P < 0.005). The proportion of early PEG placements within 0–3 days increased from 3.6 to 14.6% (P < 0.005). PEG tube insertion seems to be a safe procedure in the hands of an ORL-HN surgeon. Independence from gastrointestinal surgeons’ services reduced the time delay and improved the availability of urgent PEG insertions.

There are significant differences in how laryngeal cancer affects the two genders, with cases occuring predominantly in males. This has been speculated to result from the different susceptibilities of the tumor cells to steroid sex hormones. Since the sex hormone action is mediated by specific cellular receptors, several previous studies have analyzed the presence of these sex-hormone receptors. However, the data on the receptor status for androgen, estrogen and progesterone receptors in laryngeal carcinomas are controversial. Since some authors have suggested antiandrogen or antiestrogen therapy as an adjuvant treatment for laryngeal carcinoma, we performed a comprehensive study using immunomorphological and biochemical techniques on both in-vivo and in-vitro tumor cells in order to clarify whether major sex-hormone receptors are present or not. We performed an immunohistochemical analysis on 13 patients with laryngeal carcinomas, 8 males and 5 females, using monoclonal antibodies against androgen, estrogen and progesterone receptors. In addition, the presence of estrogen and progesterone receptors was tested biochemically using an enzyme immune assay (EIA). Furthermore, we analyzed immunohistochemically the expression of the hormone receptors in five keratinocyte cell lines originating from laryngeal carcinomas. In all of our tumor samples, as well as in the five tumor cell lines tested, we did not detect any specific immunohistochemical staining for androgen, estrogen and progesterone receptors in the laryngeal carcinoma cells when compared to the positive controls of breast and prostate cancer samples. Similarly, the biochemical analysis did not demonstrate any significant amount of receptor protein in the analyzed cases. In conclusion, the absence of male and female sex-hormone receptors strongly argues against laryngeal carcinomas being sex-hormone-dependent tumors. Therefore, we do not see any rational indication to use a specific antiandrogen or antiestrogen therapy for the adjuvant treatment of laryngeal carcinomas.

Human nasal mucosa has various types of blood vessels and is a good tissue for demonstrating receptors for many vasoactive substances, including α-adrenoceptors. In contrast to the large contractile response induced by α2-agonists, our studies have shown that α2-agonists produce a small maximal contraction. This α2-induced response was easily blocked by α1-antagonists, indicating that it is evoked, at least partially, by the stimulation of α1-adrenoceptors. Noradrenaline (NA)-induced contractions could not be abolished by either α1- or α2-antagonists alone, but were almost completely blocked by the combination of both antagonists. This suggests the presence of postjunctional α2-adrenoceptors. The low-maximal responsiveness to α2-agonists and calcium independency of NA-induced contractions were distinct from our former results obtained on canine nasal specimens.