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Videolaryngostroboscopy following frontolateral laryngectomy with sternohyoid flap
Scientific Posters
P024 Driving Problems in Patients with Vestibular Disorders Helen S Cohen, EdD OTR (presenter); Jennifer Wells, MS, OTR; Kay T Kimball, PhD; Cynitha Owsley, PhD Houston TX; Birmingham AL; Austin TX; Birmingham AL
Objectives: Driving is an important daily life task. In most communities the ability to drive a car is essential for mobility within the community. The ability to drive can be affected by vestibular disorders. Although the literature includes several articles about physicians’ beliefs about the driving skills of patients with vestibular disorders, no previous studies have examined patients’ experiences driving. The goal of this study was to determine how well patients, themselves, believe they drive. Methods: We surveyed patients with several vestibular impairments, including benign paroxysmal position vertigo (BPPV), chronic peripheral vestibulopathy, Meniere’s disease and postvestibular nerve section or acoustic neuroma, and compared them to a sample of normals. All subjects were interviewed using a normed instrument developed to evaluate patients with vision impairment and we added some questions specific to this population. Results: Normal people report no significant deficits in driving skill. BPPV patients report few problems. Other groups report more problems, especially in conditions of reduced visibility. The most problematic groups were Meniere’s disease and chronic vestibulopathies. Because of the need for mobility, most patients ignore the advice of physicians not to drive. Conclusion: These results differ from physicians’ beliefs about patients’ driving skills. Physicians and other health professionals should counsel patients with potential driving problems about the most likely problematic areas and should provide guidance about alternatives to driving when available. Patients with Meniere’s disease, chronic vestibulopathies, and those acutely after otologic surgery expecially should be counseled. Otherwise they may continue driving. Supported by NIH grants DC03602 and P50 AG11684-10.
P025 Videolaryngostroboscopy Following Frontolateral Laryngectomy with Sternohyoid Flap Walter P Cruz, MD; Rogerio Dedivitis, MD (presenter); Abrao Rapoport, MD Santos Brazil; Santos Brazil; Sao Paulo Brazil
Objectives: To analyze videostroboscopic findings in patients who underwent vertical frontolateral laryngectomy with reconstruction with sternohyoid muscle flap. Methods: A retrospective study was conducted to evaluate 21 patients staged as T1b and T2 glottic tumors. A videostroboscopic protocol was applied. Three observers analyzed the recorded data. Fisher Exact Test was applied.
Results: The glottic closure: complete in 15 and irregular vocal gaps in 6. The site of vibration: glottic in 10, supraglottic in 7 and mixed in 4. The amplitude: normal in 4, slightly diminished in 9 preserved sides, moderately or severely diminished in 16 and absent in 5 reconstructed sides. The mucosa wave vibratory pattern: always totally present in 15 preserved and in 5 reconstructed sides; normal or slightly diminished in the preserved vocal folds and moderately or severely diminished in the reconstructed ones; the reconstructed vocal folds had nonvibrating portion in 5 cases. The movement extension of the preserved side: larger than the other in 8 and similar in 13. The symmetry: regular in 18. The periodicity: always/generally regular in 9. There was supraglottic hyperadduction in 16. The mucosal appearance: normal in 15 and humid in 6. The epiglottis: straight in 14 cases and in crescent in 7. Mucus formation: in one patient in the posterior vibratory portion. Conclusion: Videolaryngostroboscopy allowed thorough evaluation the vibratory pattern of the vocal folds in 52.4%. The supraglottic hyperadduction component and the supraglottic vocal source presented difficulty for this evaluation. The site of vibration was glottic in 47.6%, supraglottic 33.3%, and mixed in 19.1%. P026 Labyrinthine Fistulae as a Complication of Chronic Suppurative Otitis Media Dragoslava Djeric, MD PhD (presenter); Snezana S Babac, MD Belgrade Yugoslavia; Belgrade Yugoslavia
Objectives: The aim of this study is to present observation concerning clinical features, diagnosis and menagement of labyrinthine fistulae secondary to chronic suppurative otitis media. Methods: The authors studied 160 surgically treated patients with labyrinthine fistulae due to chronic otitis media with cholesteatoma. The material does not include erosion or incomplete fistula presenting itself as a bluish line on the labyrinth, but with a layer of bone is still intact. Results: In 136 (85.5%) of operated ears, the labyrinthine fistulae were found at the first surgery and in 24 (14.5%) at a reoperation. In a number of patients other complications were associated with the fistula such as peripheral facial paralysis, meningitis, and brain abscess. Total deafness and sensorineural hearing loss are commonly occurred with labyrinthine fistulae (63.1%). Preoperative fistula test was negative in 42% patients. The multiple fistulae were found in 14% patients. The fistulae were most commonly localized on the lateral semicircular canal (l 7%) and much less frequently involved only the oval window area (7%) and promontory (4%). The closed technique was used, while the open technique was adopted only when the ear was deaf preoperatively, in cases of multiple fistulae and associated intracranial complications. Conclusion: The cholesteatoma matrix should not be re-
POSTERS
P248
Otolaryngology– Head and Neck Surgery August 2004
P024 Driving Problems in Patients with Vestibular Disorders Helen S Cohen, EdD OTR (presenter); Jennifer Wells, MS, OTR; Kay T Kimball, PhD; Cynitha Owsley, PhD Houston TX; Birmingham AL; Austin TX; Birmingham AL
Objectives: Driving is an important daily life task. In most communities the ability to drive a car is essential for mobility within the community. The ability to drive can be affected by vestibular disorders. Although the literature includes several articles about physicians’ beliefs about the driving skills of patients with vestibular disorders, no previous studies have examined patients’ experiences driving. The goal of this study was to determine how well patients, themselves, believe they drive. Methods: We surveyed patients with several vestibular impairments, including benign paroxysmal position vertigo (BPPV), chronic peripheral vestibulopathy, Meniere’s disease and postvestibular nerve section or acoustic neuroma, and compared them to a sample of normals. All subjects were interviewed using a normed instrument developed to evaluate patients with vision impairment and we added some questions specific to this population. Results: Normal people report no significant deficits in driving skill. BPPV patients report few problems. Other groups report more problems, especially in conditions of reduced visibility. The most problematic groups were Meniere’s disease and chronic vestibulopathies. Because of the need for mobility, most patients ignore the advice of physicians not to drive. Conclusion: These results differ from physicians’ beliefs about patients’ driving skills. Physicians and other health professionals should counsel patients with potential driving problems about the most likely problematic areas and should provide guidance about alternatives to driving when available. Patients with Meniere’s disease, chronic vestibulopathies, and those acutely after otologic surgery expecially should be counseled. Otherwise they may continue driving. Supported by NIH grants DC03602 and P50 AG11684-10.
P025 Videolaryngostroboscopy Following Frontolateral Laryngectomy with Sternohyoid Flap Walter P Cruz, MD; Rogerio Dedivitis, MD (presenter); Abrao Rapoport, MD Santos Brazil; Santos Brazil; Sao Paulo Brazil
Objectives: To analyze videostroboscopic findings in patients who underwent vertical frontolateral laryngectomy with reconstruction with sternohyoid muscle flap. Methods: A retrospective study was conducted to evaluate 21 patients staged as T1b and T2 glottic tumors. A videostroboscopic protocol was applied. Three observers analyzed the recorded data. Fisher Exact Test was applied.
Results: The glottic closure: complete in 15 and irregular vocal gaps in 6. The site of vibration: glottic in 10, supraglottic in 7 and mixed in 4. The amplitude: normal in 4, slightly diminished in 9 preserved sides, moderately or severely diminished in 16 and absent in 5 reconstructed sides. The mucosa wave vibratory pattern: always totally present in 15 preserved and in 5 reconstructed sides; normal or slightly diminished in the preserved vocal folds and moderately or severely diminished in the reconstructed ones; the reconstructed vocal folds had nonvibrating portion in 5 cases. The movement extension of the preserved side: larger than the other in 8 and similar in 13. The symmetry: regular in 18. The periodicity: always/generally regular in 9. There was supraglottic hyperadduction in 16. The mucosal appearance: normal in 15 and humid in 6. The epiglottis: straight in 14 cases and in crescent in 7. Mucus formation: in one patient in the posterior vibratory portion. Conclusion: Videolaryngostroboscopy allowed thorough evaluation the vibratory pattern of the vocal folds in 52.4%. The supraglottic hyperadduction component and the supraglottic vocal source presented difficulty for this evaluation. The site of vibration was glottic in 47.6%, supraglottic 33.3%, and mixed in 19.1%. P026 Labyrinthine Fistulae as a Complication of Chronic Suppurative Otitis Media Dragoslava Djeric, MD PhD (presenter); Snezana S Babac, MD Belgrade Yugoslavia; Belgrade Yugoslavia
Objectives: The aim of this study is to present observation concerning clinical features, diagnosis and menagement of labyrinthine fistulae secondary to chronic suppurative otitis media. Methods: The authors studied 160 surgically treated patients with labyrinthine fistulae due to chronic otitis media with cholesteatoma. The material does not include erosion or incomplete fistula presenting itself as a bluish line on the labyrinth, but with a layer of bone is still intact. Results: In 136 (85.5%) of operated ears, the labyrinthine fistulae were found at the first surgery and in 24 (14.5%) at a reoperation. In a number of patients other complications were associated with the fistula such as peripheral facial paralysis, meningitis, and brain abscess. Total deafness and sensorineural hearing loss are commonly occurred with labyrinthine fistulae (63.1%). Preoperative fistula test was negative in 42% patients. The multiple fistulae were found in 14% patients. The fistulae were most commonly localized on the lateral semicircular canal (l 7%) and much less frequently involved only the oval window area (7%) and promontory (4%). The closed technique was used, while the open technique was adopted only when the ear was deaf preoperatively, in cases of multiple fistulae and associated intracranial complications. Conclusion: The cholesteatoma matrix should not be re-
POSTERS
P248
Otolaryngology– Head and Neck Surgery August 2004