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Query: UMLS:C0262471 (ENT)
 5,307 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 69-year-old woman was examined because of progressive dysphagie. A barium esophagogram showed no obstruction but a swallowing in trachea suggested a neuromuscular disorder. ENT examination showed no specific signs of infection. The clinical diagnosis of tetanus was confirmed by electromyography. This case demonstrates an uncommon cause of dysphagia where the classical signs of tetanus in the early stages of this disease were absent and dysphagia was the initial and sole presenting symptom.
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PMID:[Dysphagia as initial symptom in tetanus. A case report]. 175 7

We present the results of a prospective study of 388 patients presenting with a history of swallowing a foreign body. We indicate whether the patients' symptoms and signs were associated with a retained foreign body. While tenderness on palpation was an unreliable sign, pooling at indirect laryngoscopy invariably predicted a retained object. In many patients, initial careful examination of the oropharynx by casualty officers would have shown a retained fishbone in the tonsil or tongue and would have resulted in 16 per cent fewer radiographs and 17 per cent fewer referrals to the ENT department. Radiography only improved management in a small minority and 35 per cent of films were interpreted incorrectly by casualty officers. A follow-up barium swallow disclosed a pathological lesion in a significant proportion of patients with bolus obstruction, whether or not this was passed spontaneously.
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PMID:Foreign bodies in the throat: a prospective study of 388 cases. 201 17

A 10-year retrospective survey of 204 elective rigid oesophagoscopic examinations in the ENT unit of a District General Hospital is reported. One Hundred and Forty Five (71 per cent) were normal and there was marked preponderance of normal endoscopy in patients under 60 years old. Clinical examination was usually unhelpful but barium studies were found to complement oesophagoscopy in reaching a diagnosis. There were six complications of oesophagoscopy, two following normal examinations.
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PMID:Rigid endoscopy in ENT practice. Appraisal of the diagnostic yield in a district general hospital. 357 34

The symptom dysphagia is defined and an interdisciplinary team approach emphasized. A step like diagnostic approach in oropharyngeal dysphagia is described, including transnasal pharyngo-laryngo-fiber endoscopy, videofluoroscopy and the "modified barium swallow." First, all of the organic changes causing oropharyngeal dysphagia must be recognized, both "typical ENT diseases" and malignant tumors of the oropharynx and hypopharynx, which are usually diagnosed only at an advanced stage. Of particular interest is postoperative dysphagia with or without aspiration. If there is no evidence of an organic cause in the field of otorhinolaryngology, in making a differential diagnosis dysfunction of the upper esophageal sphincter and a "globus pharyngis" have to be ruled out.
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PMID:[Differential diagnosis of dysphagia]. 836 20

The authors report a series of eight cases of isolated tracheoesophageal fistula without esophageal atresia (or an H type fistula), treated in three pediatric ENT departments. This is a rare malformation whose diagnosis requires investigation for associated anomalies. The clinical signs are mainly respiratory but also digestive and the symptomatology can be severe. The diagnosis can be made with a barium swallow combined with cineradiography, but a tracheoesophageal endoscopy remains the investigation of choice. The treatment is surgical. In most cases, the fistula is accessible by a right or left cervicotomy, depending on the surgeon's practice, with a much lower postoperative morbidity as compared to a thoracotomy. The postoperative management was straightforward in most of our cases. We discuss the role of gastro-esophageal reflux with respect to postoperative morbidity as well as systematic treatment for reflux peri-operatively. The pros and cons of the various surgical approaches are also discussed.
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PMID:Congenital tracheoesophageal fistula without esophageal atresia. 1040 20

Endoscopic laser resection of hypopharyngeal diverticula has been used in the ENT Department, Odense, Denmark, since 1989. The outcome of treatment is reported in this presentation. Of the 61 patients, 32 (52%) were males. Age at operation was 72 years (median), range 37-94 years. The diagnosis in all patients was confirmed by barium radiography of the hypopharynx and the oesophagus. A Benjamin-Hollinger diverticuloscope was used for viewing the tissue bridge separating the diverticulum and the oesophagus. The tissue bridge was cut from the apex to the base using a CO2 laser. Perioperative complications were seen in 6 patients: Bleeding (1), subcutaneous emphysema without (3) or with (1) inflammation, inflammation without emphysema (1). The duration of postoperative nasogastric feeding was 2 days (median) (range 1-11 days). Fifty-four patients received prophylactic antibiotic treatment for a median of 3 days (range 0.5-13 days). The duration of postoperative hospitalization was 3 days (median) (range 2-14 days). The patients were routinely examined 2-3 months postoperatively. There were recurrences in 6 patients (10%), all successfully re-operated. A follow-up questionnaire was sent to patients who had finished their postoperative examination in March 1999. All 37 patients still alive responded. Median follow-up time was 37 months (range 3-96 months). Two patients reported recurrence at the time of follow-up and have been successfully re-operated. Eight patients reported minor and intermittent symptoms that did not indicate further evaluation. We conclude that laser resection of hypopharyngeal diverticula is an efficient therapy, which is applicable to and well tolerated in the great majority of patients. The rate of recurrence is low and re-operation can be performed without difficulty.
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PMID:Endoscopic CO2 laser therapy of Zenker's diverticulum--experience from 61 patients. 1090 28

The primary cricopharyngealis achalasia (PCA) is a very uncommon functional disorder of the upper oesophageal sphincter (UES) characterized by dysphagia, frequent aspiration, and impaired relaxation of the UES. It should be differentiated from diseases of neuromuscular and ENT origin, from organic causes and other types of cricopharyngeal dysfunction. On suspected oesophageal inlet stenosis, swallow x-ray studies using water-soluble contrast material is performed, followed by oesophagoscopy. If the endoscope cannot pass into the oesophagus, balloon dilatation is performed to reach a diameter of 12-15 mm. This facilitates the passing of the endoscope and helps ruling out organic causes. If the stenotic segment dilates easily, the mucosa is intact, and no mechanical obstruction is discovered, then UES manometry is performed to differentiate from other motility disorders. Extraluminal causes are excluded using endosonography and CT. If PCA is diagnosed, low-pressure (1-1.5 atm) balloon dilatation is continued under fluoroscopic control until a lumen diameter of 18-20 mm is obtained. Efficacy of dilatation is assured clinically as well as with endoscopical, barium swallow and manometric studies. Five out of 28 patients with pharyngo-oesophageal dysphagia were found to have PCA. Patients presented with severe dysphagia and a predisposition to aspiration. The radiographic examination demonstrated stenosis at the UES level, and aspiration. It was possible to introduce the endoscope into the oesophagus only two of the five patients before the dilatation. The manometry was not pathognomonic, its value did not achieve the expectations. In contrast with organic stenoses, UES dilated easily using balloon catheter. Thereafter, the endoscope passed smoothly through the UES in each of cases. Following progressive dilatation--with low pressure (1.5-2 atm) up to 20 mm in diameter-, superficial mucosal damage was observed in one patient only. Patients' complaints ceased after treatment, and the barium swallow showed normal passage. Redilatation was necessary only in one case after following 21 (7-33) months. The authors supposed that the gastrooesophageal reflux plays role in the pathogenesis of PCA. Balloon catheter dilatation is an important diagnostic and at the same time effective, first choice, minimal invasive therapeutic method in PCA.
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PMID:[Primary cricopharyngeal achalasia and its dilatation with balloon catheter]. 1107 94

Globus pharyngeus is a common complaint often referred to the ENT outpatient department. The precise nature of globus pharyngeus and its aetiology remains something of a mystery. There is no uniform policy of management of this condition. A postal questionnaire was sent to all UK-based ENT consultants registered with the British Association of Otorhinolaryngolgists-Head and Neck Surgeons (BAO-HNS). The aim of this study was to ascertain if there was a favoured management policy by the majority of consultants. Our results indicate that there is a lack of consensus in the investigation and management of globus pharyngeus. Fourteen per cent do not perform any investigations, but would prescribe antacid medication if clinically indicated. The remainder would investigate in a variety of ways. The most common investigation is rigid endoscopy which is performed by 61% of respondents, followed by barium swallow (56%). The combination of endoscopy and barium swallow is routinely performed by 17.5% of respondents.
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PMID:Globus pharyngeus: a postal questionnaire survey of UK ENT consultants. 1112 1

Globus pharyngeus as a possible presenting symptom of a pharyngeal or upper oesophageal neoplasm is the main reason why barium swallows are requested, although it is essentially a benign disorder that in many cases requires reassurance only. We therefore retrospectively reviewed all barium swallows done in our department for globus pharyngeus during a one-year period to assess their value in the investigation of this condition. Ninety-two patients were identified. All had a normal ENT examination, and symptoms suggestive of acid reflux was the most common associated complaint, at 11 per cent. Acid reflux (18.5 per cent) and hiatus hernia (12 per cent) were the commonest findings of a barium swallow. Three cases of suspicious findings on barium swallow had a normal examination under general anaesthetic. Statistical analysis showed no significant relationship between the symptoms of globus and the barium swallow results. A barium swallow does not seem to add any further useful information to the investigation of globus pharyngeus. But most globus patients will continue to undergo a barium swallow, because although alternative investigations have been extensively assessed, it is still not clear which is the most appropriate mode of investigation for this condition.
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PMID:Value of barium swallow in investigation of globus pharyngeus. 1117 65

A 40-year-old woman with an uneventful history consulted for an episode of cervical swelling and pharyngeal disorders with sensation of a foreign body. Cervical and ENT examination was normal. The barium swallow showed a normal esophagus and the CT scan showed an air image in the right side of the trachea. The diagnosis of tracheocele was made at surgery and was confirmed by histology. Clinical, endoscopic, and radiologic outcome was favorable three months after surgical resection of the diverticulum. Tracheocele is rarely reported in the literature. It results from a congenital or acquired weakness of the tracheal wall. The right side is involved more frequently. No specific signs or symptoms have been identified. Diagnosis is often based on CT findings. Surgery confirms the diagnosis and allows resection.
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PMID:[Tracheocele: a rare cause of pharyngeal disorders]. 1221 75


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