Deep space infections of head and neck of dental origin

Deep space infections of head and neck of dental origin

OtolaryngologyHead and Neck Surgery Volume 121 Number 2 Conclusions: Orbital complications of sinusitis were the most common ones. The prompt diagnos...

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OtolaryngologyHead and Neck Surgery Volume 121 Number 2

Conclusions: Orbital complications of sinusitis were the most common ones. The prompt diagnosis and adequate therapy of complications of sinusitis are important to improve the outcome of these disorders. 48

The Role of Rhinitis in Chronic Otitis Media: A Preliminary Study OLAVO G MION MD; JOAO FERRERIA DE MELLO JR MD; Sao Paulo Brazil

Objectives: The role of rhinitis in middle ear disease is very controversial. Although there is clinical evidence of nasal inflammatory disease affecting eustachian tube function and the middle ear mucosa, there is no scientific proof of that fact. Our objective is to investigate which is the role of allergic rhinitis in chronic otitis media (otitis media with effusion and chronic tympanic membrane perforation) in Sat Paulo and whether there is an association between those diseases. Methods: We studied 30 patients who were submitted to surgery for tympanostomy tubes (9) for otitis media with effusion, or for tympanoplasty (21) for chronic tympanic perforations under treatment at the Otology Group of the University of Sat Paulo. On the basis of clinical history, physical examination, skin-prick tests, and nasal cytology, patients were categorized as having allergic rhinitis (10), nonallergic rhinitis with eosinophils (NARES) (8), or no rhinitis (12). We evaluated the degree of nasal disease and the results of surgery in each group. Results: A total of 30 patients were studied; the age ranged from 5 to 49 years (mean 23.1 years). Men accounted for 60%. Of the total, 33.3% were allergic, 26.6% had nonallergic rhinitis with eosinophils (NARES), and 40% were without rhinitis. The number of surgeries was forty, 27 (67.5%) tympanoplasties and 13 (32.5%) tympanostomies for ventilation tubes. The surgery outcome was positive in 35%. Of patients undergoing tympanoplasties, 28.5% were in the NARES group, and of patients undergoing tympanostomies 44.4% had allergic rhinitis. Conclusion: In patients surgically treated for otitis media with effusion, there was a prevalence of allergic rbinitis. In tympanoplasty patients there was a prevalence of NARES. The majority of our patients had perennial disease because they live in a tropical country. Our patients behave differently in rhinitis. This is a preliminary study, and although our casuistic is low, we found an association between rhinitis and middle ear disease. 49

Deep Space Infections of Head and Neck of Dental Origin PETERBAPTISTAMD PHD; AURA DIAZ M DE PALACIOS MD; SERGIO A ARENAS MD; VIRGINIA CAMELI MD; Caracas Venezuela

Objectives: To evaluate the occurrence of deep space

Scientific Posters

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infections of the head and neck related to dental origin, its dissemination pathways, and complications, clinical, and surgical management at the ORL Department of Hospital Universitario de Caracas, Venezuela. Methods: A prospective follow-up study was made with 148 patients with deep space infections of head and neck who required hospitalization in the ORL Department of Hospital Universitario de Caracas, Venezuela, from January 1995 to December 1998. They were studied by taking culture samples, CT scans, and radiographic studies. The therapeutic management is described. Results: Overall, we evaluated 35 patients (20 male [57.14%] and 15 female [42.86%]) coursing with deep space infections of head and neck of dental origin. The mean age was 27.74 years, with a frequency peak between 11 and 30 years. The most frequent dissemination area was the masticatory and submandibular spaces. The bacterial flora isolated were usually multiple aerobic and anaerobic strains. Two of these cases were complicated with mediastinal dissemination of the infection. One death was registered. Six patients required cervicotomy, 18 underwent surgical puncture drainage, and 11 presented spontaneous drainage. All the patients receive antibiotic treatment with appropriate response to penicillin alone or associated to chloramphenicol. Clindamycin was used in patients allergic to penicillin. Conclusion: Deep space infections of head and neck of dental origin represent a challenge of diagnosis and medical and surgical treatment due to potentially severe and life-threatening complications. They represent a public health problem due to the cost originated from the hospitalization, surgical procedures, and other medical treatment. They also affect people during a productive time of life.

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Does Voice Therapy Work? An RCT of Voice Therapy for Dysphonia KENNETH MACKENZIE MB CHB FRCS; I J DEARY PHD; AUDREY MILLAR BSC MPHIL; JANET A WILSON MD FRCS; Glasgow United Kingdom; Edinburgh United Kingdom; Glasgow United Kingdom; Newcastle U Tyne United Kingdom

Objectives: An estimated 40,000 patients undergo voice therapy for dysphonia annually in the UK, yet there is little level 1 evidence for its efficacy. We aimed to assess the efficacy of voice therapy in a double-blind prospective RCT. Methods: We studied 204 outpatients aged 17 to 87 years who presented with a primary symptom of persistent hoarseness. Laryngoscopic, demographic, and social data were recorded. Baseline measures were of (1) voice quality (VPQ, BVP), (2) psychological distress (HADS, CIS), and (3) quality of life (SF36). Randomization was to either voice therapy or no treatment. Measures were repeated at the end of 6 weeks