The Laryngoscope
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Comparative Study Clinical Trial Controlled Clinical Trial
Effects of droperidol in management of vestibular disorders.
The chemo-therapy of vestibular disease has involved a wide spectrum of pharmacological agents insofar as their mode of action is concerned. In our experience, however, droperidol is one pharmaceutical agent which is remarkably effective in depressing vestibular disturbance regardless of etiology. This medication (also called Inapsine) belongs to a relatively new class of compounds known as butyrophenones and its pharmacological action can best be described as a dopa blocking agent. ⋯ This therapy clearly provided the statistically significant response (p less than 0.1, Fisher's Exact Test). This was particularly apparent at the 60-minute evaluation point. While some of the patients receiving Inapsine had recovered earlier, by 60 minutes none of the placebo patients but all of the Inapsine patients had recovered from the vestibular symptoms of Ménière's disease...
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Pain in the ear is a common complaint for which patients consult their otolaryngologist. A rare cause is geniculate neuralgia, which has also been called tic douloureux of the nervus intermedius. In its most typical form, it is characterized by severe paroxysmal neuralgic pain centered directly in the ear. ⋯ Afferent sensory facial nerve fibers are shown to pass not only through the nervus intermedius, but also through the main motor trunk of the facial nerve. Excision of the nervus intermedius and/or of the geniculate ganglion by the middle cranial fossa approach without the production of facial paralysis, in any of 15 cases with geniculate neuralgia is reported. Use of these new techniques, sometimes in combination with selective section of the Vth cranial nerve, has been successful in relieving the pain of geniculate neuralgia.
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This article reviews some of the problems involved in direct laryngoscopy. It suggests adequate preparation and evaluation of the patient to avoid complications. ⋯ The importance of correct positioning of the patient is emphasized and illustrated. This summarizes clinical judgment and successful evaluation of the difficult mechanical problems in the exposure of the vocal cords.
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Seventy-three tracheostomies performed in children three years of age and under in a 52-month period are discussed. Thirty-six were under one year of age. Forty-one were performed for upper airway obstruction, 23 for ventilation or suction, and nine for a combination of upper airway obstruction and lower bronchopulmonary disease. ⋯ Sixteen were due to the patients' diseases; four were due to complications of tracheostomy. If serious operative and postoperative complications are avoided, the important factors determining prognosis are the patient's age and the condition for which the tracheostomy was done. The long term results in these patients show this to be true for both survival and duration of tracheostomy.
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Hearing impairment is not often considered a potential complication of general anesthesia; however, four patients who sustained hearing loss following nitrous oxide inhalation anesthesia have recently come to the authors' attention. The cases are presented and middle ear pressure measurements taken during endotracheal inhalation anesthesia with various agents are reported. Factors predisposing to hearing loss during anesthesia are discussed.