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ENT AND Dry mouth xerostomia [keywords]
- [Analysis of quality of life outcome for nasopharyngeal carcinoma patients after treatment]. [English Abstract, Journal Article]
- Laryngorhinootologie 2013 Apr; 92(4):244-50.
This retrospective study analysed patient characteristics and quality of live (QoL) for patients with nasopharyngeal carcinoma (NPC) after treatment.A cross-sectional investigation was conducted to assess the QoL of 20 NPC patients with cancer-free survival of more than one year, which were treated with radiotherapy (RT) or chemoradiotherapy (RCT) during the period 2001-2009 at the University Hospital Bonn, Germany. The QoL was assessed by the FACT-NP (functional assessment of cancer therapy-nasopharyngeal) questionnaire.The median age of the patients was 57±13 years and the male/female ratio was 2.33/1.3 (15%) patients were treated with RT and 17 (85%) with RCT. The global QoL was good in our patients. Xerostomia, chewing, decrease of gustatory sense, discontent with sexual life and ear problems were of major concern with the majority of patients and affected the QoL negatively. Pain, lost of working ability, emotional distress, or family problems were no significant factors.The expected reduction of QoL after treatment must be explained in detail to the NPC patient. The integration of the family and partner, an antidepressant therapy or psycho-oncological support can be useful and necessary.
- Protective effects of resveratrol on salivary gland damage induced by total body irradiation in rats. [Comparative Study, Journal Article]
- Laryngoscope 2012 Dec; 122(12):2743-8.
One of the most common acute side effects of irradiation is xerostomia, which results from damage to the salivary gland cells by direct ionization. Resveratrol is a natural compound with profound anti-inflammatory and antioxidant properties. The purpose of the present study was to investigate the potential protective effects of resveratrol on injury to the salivary glands of rats that were exposed to total body irradiation.An experimental study at the Inonu University School of Medicine.Twenty-nine female rats were randomized into four groups: group 1, high-dose (100 mg/kg) resveratrol group (n = 7); group 2, low-dose (10 mg/kg) resveratrol group (n = 7); group 3, control (vehicle) rats (n = 7); and group 4, sham-irradiation group (n = 8). The medications were administered as single doses, and the rats were exposed to total body irradiation 24 hours after the treatment. The animals were sacrificed the following day, and the parotid and submandibular glands were excised. Salivary gland histology and the tissue levels of glutathione (GSH), nitric oxide (NO), and malondialdehyde (MDA) were investigated.The rats in group 1 showed significantly decreased acinar loss and less ductal damage and cell necrosis than those of the control group (P < .05). Antioxidant GSH levels were significantly increased by high doses of resveratrol treatment. The tissue activities of MDA in both the parotid and submandibular glands were significantly reduced in group 1. Low-dose resveratrol treatment did not significantly alter the tissue levels of MDA.Resveratrol at relatively high doses can reduce the irradiation-dependent salivary gland damage, suggesting that this natural antioxidant may be effectively used to lessen the side effects related to salivary gland dysfunction that is induced by irradiation.
- Ectodermal dysplasia: otolaryngologic evaluation of 23 cases. [Journal Article]
- Ear Nose Throat J 2012 Feb; 91(2):E28-33.
The aim of this prospective study was to improve the quality of life of and reduce morbidity for patients with ectodermal dysplasia by assessing their actual and potential ENT pathologies, and offering methods of prevention and treatment. The study was conducted between 2006 and 2008 and included 23 patients diagnosed with ectodermal dysplasia. The major symptoms of ectodermal dysplasia were evaluated. Patient histories were obtained in all cases, and a complete head and neck examination was carried out. Of the 23 patients (11 males and 12 females, aged 5 to 45 years) diagnosed with ectodermal dysplasia, 22 had hypohidrotic ectodermal dysplasia and 1 had ectrodactyly-ectodermal dysplasia-clefting syndrome. In all patients diagnosed with hypohidrotic ectodermal dysplasia, the salivary glands were examined by ultrasonography and, when necessary, by scintigraphy. Hearing defects in patients with otologic problems were determined by audiometric examination: 39.1% of the patients had hearing loss, 43.5% had otitis media, and 39.1% had impacted cerumen. The most common rhinologic findings were saddle nose deformity in 56.5%, nasal obstruction and nasal dryness (52.2% each), and chronic rhinitis/rhinosinusitis (34.8%). The most common oral and oropharyngeal findings were difficulty chewing in 82.6% and dry mouth in 78.3%. All 23 patients had required dental work. Because this disorder affects several aspects of the body, its treatment requires a multidisciplinary approach, with the otolaryngologist being a vital part of the management team.
- Bilateral multicystic parotid masses in primary Sjögren syndrome. [Case Reports, Journal Article]
- Ear Nose Throat J 2011 Oct; 90(10):E20-2.
We report the case of a 48-year-old woman who presented with bilateral parotid gland enlargement as the initial manifestation of primary Sjögren syndrome. Magnetic resonance imaging demonstrated multiple areas of low-intensity signal mixed with foci of high-intensity signal, a finding suggestive of Sjögren syndrome. Autoimmune blood tests for Sjögren syndrome were positive, and a sublabial biopsy confirmed the diagnosis. Investigations for other conditions, including human immunodeficiency virus infection, were negative. After 5 years of follow-up, the parotid swellings remained essentially unchanged. We discuss the etiology of multicystic parotid gland pathology, its involvement in Sjögren syndrome, and the risk of lymphoma.
- Conservation of salivary function and new external head and neck radiation techniques. [Journal Article, Review]
- Eur Ann Otorhinolaryngol Head Neck Dis 2010 Dec; 127(6):197-203.
New radiation therapy techniques seek to adapt dose distribution to three-dimensional tumor geometry, so as to deliver the lowest possible dose to normal tissue and at-risk organs. This is expected to enhance locoregional control and survival and to reduce complications and thereby improve quality of life. Post-radiation xerostomia significantly deteriorates quality of life.New external radiation techniques (such as intensity-modulated conformal radiation therapy, RapidArc VMAT arc therapy, tomotherapy, CyberKnife(®), protontherapy, use of carbon ions) applicable in ENT are reviewed.Preliminary data show interesting results in terms of salivary function with highly conformal techniques.In France, assessment is ongoing, financed under the Health Ministry's "Support for Expensive Innovatory Techniques" scheme (STIC [Soutien aux techniques innovantes coûteuses]), as routine use is growing rapidly.
- Treatment of postsurgical pyoderma gangrenosum with a high-potency topical steroid. [Case Reports, Journal Article]
- Ear Nose Throat J 2010 Jun; 89(6):E5-7.
Pyoderma gangrenosum is a rare disease characterized by chronic, nonhealing, noninfectious ulcers that can become exacerbated by trauma or manipulation, including surgical treatment. We describe the case of a 30-year-old woman who presented with a large ulcer at the site of an excisional cervical lymph node biopsy; she also had a smaller ulcer at the site of an earlier biopsy that had been previously well healed. The ulcers persisted despite local care, and the larger ulcer was exacerbated by surgical debridement. Histopathology revealed the presence of intense neutrophilic infiltrates with sterile microabscesses-a finding consistent with pyoderma gangrenosum. With 9 weeks of treatment with a high-potency topical steroid, both ulcers gradually healed.
- [Autoimmune sialadenitis]. [English Abstract, Journal Article]
- HNO 2010 Mar; 58(3):200-10.
Using the European-American classification criteria the diagnosis of autoimmune sialadenitis in Sjögren's syndrome can generally be easily established or excluded. In addition, sonography performed by the ENT physician is helpful in diagnosing and especially in follow-up screening for MALT lymphomas, which 5%-10% of patients develop. Therapy of sicca symptoms is primarily symptomatic using substitution with fluids and stimulation with oral cholinergic drugs. Corticosteroids and/or antibiotics may play a role in patients with severe inflammatory episodes of autoimmune sialadenitis. Systemic therapy with immunomodulatory drugs such as azathioprine or cyclophosphamide is reserved for patients with extraglandular manifestations. However, the efficacy of this therapy is not proven by clinical studies. Rituximab, a new monoclonal CD20 antibody, seems to offer the first possibility of a causal therapy, under which the lymphoepithelial lesions in the salivary glands can disappear and saliva production improves. However, larger clinical studies are needed to evaluate the efficacy of this new therapy. Optimal treatment of autoimmune sialadenitis requires interdisciplinary collaboration between ENT physician, oral and maxillofacial surgeon, rheumatologist, ophthalmologist, dentist, and pathologist.
- In vivo confocal microscopy of conjunctival goblet cells in patients with Sjogren's syndrome dry eye. [Journal Article, Research Support, Non-U.S. Gov't]
- Br J Ophthalmol 2010 Nov; 94(11):1454-8.
To study the morphology and the density of conjunctival goblet cells (GC) in patients with Sjögren's syndrome dry eye with in vivo laser scanning confocal microscopy (LSCM), and to explore its correlation with the GC density detected by impression cytology.A total of 43 Sjögren's syndrome dry eye patients were recruited. All were required to fill in the Ocular Surface Disease Index Questionnaires. The tear break-up time was measured, followed by corneal fluorescein staining examination and Schirmer I test. The images of conjunctiva were taken by the Heidelberg retina tomography (HRT-II)/Rostock cornea module. Finally, the specimens for impression cytology were obtained. SPSS V.13.0 software was used to analyse the data.Tear film function test showed that all patients had moderate to severe dry eye. The GC in LSCM images was characterised as a large hyper-reflective oval-shape cell with relatively homogeneous brightness. Though GC density assessed by LSCM (332 ± 137) cells/mm² was higher than that measured by impression cytology (200 ± 141) cells/mm², they showed a significant positive correlation, ρ = 0.908 (p < 0.05). Conclusion Conjunctival GC could be easily discriminated under the LSCM. LSCM may be a valuable tool in monitoring the progress and the follow-up of patients with Sjögren's syndrome dry eye.
- Managing the patient presenting with xerostomia: a review. [Journal Article, Review]
- Int J Clin Pract 2010 Feb; 64(3):404-7.
Patients complaining of a dry mouth can present themselves to various clinicians such as the primary care physician, dentists, otolaryngologists and/or oral surgeons. The aim of our review is to provide a systematic method of assessing and managing these patients based on current best evidence published in the literature.A literature search was performed on 20th April 2009 using MEDLINE and EMBASE using the terms dry mouth and xerostomia in combination with diagnosis, management, investigations and treatment.There appears to be little correlation between patient symptoms and objectives tests of salivary flow. Therefore clinical management should be based on patient symptoms. There is good evidence to support that xerostomia is commonly associated with anticholinergic drugs, and altering such agents plays an important role in the management of these patients. In patients with residual salivary gland function, the use of salivary stimulants appears to be more beneficial than salivary substitutes.Xerostomia can be debilitating and primarily affects the middle aged and elderly population. The most common causes of xerostomia include medications with anticholinergic properties, dehydration, diabetes and radiotherapy for head and neck cancer. Treatment of xerostomia essentially involves addressing the cause followed by salivary substitutes and/or salivary stimulants.
- A patient with dry mouth. [Journal Article, Review]
- Clin Otolaryngol 2009 Aug; 34(4):358-63.
Xerostomia is a common symptom among patients referred to ENT clinics. We present an evidence-based approach in a patient complaining of xerostomia who has not been exposed to radiotherapy. METHOD (search strategy): This review was based on a literature search last performed on 1 July 2008. MEDLINE and EMBASE databases and the Cochrane Library were searched using the subject headings dry mouth, hyposalivation and xerostomia in combination with diagnosis, therapy and surgery. Results were limited to English language articles including clinical trials, randomised controlled trials, meta-analyses, systematic reviews, review articles and human studies. Relevant references from selected articles were reviewed.Xerostomia is not synonymous with hyposalivation. Effective management covers symptomatic relief with selected saliva substitutes, sialogogic agents, addressing underlying dental complications and oral infections, and review of prescribed medication.Xerostomia is a common symptom for a wide range of triggering factors, but the treatment is largely palliative and preventative in nature.