Radiotherapy-Induced Hearing Loss in Patients with Laryngeal and Hypopharyngeal Carcinomas

The purpose of this study was to investigate a hypothesized correlation of development of a sensorineural hearing loss and radiotherapy in patients with laryngeal and hypopharyngeal carcinoma. This prospective study included a total of 50 patients, which after strict exclusion critera (audiologic problems before RT, primary tumors of the auditory system, spread of the primary tumor to any part of the auditory system) resulted in 23 analyzed patients, ranging between 50 and 76 years of age, with a mean age of 60. Audiometry measuring frequency-specific thresholds was performed in three time points: one month before radiotherapy, one and six months after radiotherapy. A significant statistical difference in hearing tresholds after radiotherapy was found in 6 out of 23 patients. An obvious tendency towards hearing loss without statistical significance at 250 and 4000 Hz was found for a whole tested population (p≤0.3 with Bonferroni correction). Observed tendency towards hearing loss after radiotherapy of laryngeal carcinoma was related to side of the tumor and less severe when chemotherapy was not added as adjuvant therapy. These results should help to decrease a rate of hearing loss by careful planing of ear protection, by using observed frequencies as relevant markers of hearing loss and by reconsidering adjuvant chemoterapy during radiotherapy of laryngeal carcinoma

Haemodynamic effects and the visibility of the surgical field after lidocaine infiltration during septoplasty under general anaesthesia

Background and Purpose: The aim of this study was to determine the effect of local infiltration of adrenaline- containing lidocaine solution during septoplasty under general anaesthesia on systemic haemodynamics and the visibility of the operative field, and to compare it to the topical application of ephedrine. Patients and Methods: A retrospective, comparative, non-randomised, open study on 72 ASA physical status I and II patients, aged 20 to 73 years, scheduled for septoplasty was performed. Lidocaine/adrenaline-ephedrine group (group LA-E; n=18) received four cotton pledgets soaked with 1 % ephedrine, and then the submucosal infiltration of 2% lidocaine containing adrenaline solution (2ml) plus plain 2% lidocaine solution (5ml). Lidocaine/ adrenaline group (LA group; n=25) received the submucosal infiltration of 2% lidocaine containing adrenaline solution (2ml) plus plain 2% lidocaine solution (5ml). Ephedrine group (E group; n=29) received four cotton pledgets soaked with 1% ephedrine. Heart rate (HR) and mean arterial pressure (MAP) were recorded at predetermined time intervals. Bleeding in the surgical field was rated according to a 6-point scale. Results: LA and LA-E groups showed significant lower HR and MAP compared to E-group. LA group showed only slight oscillations in HR. Average bleeding score was 2.28±0.83 in LA-E, 2.08±0.81 in LA and 3.14±0.74 in E group (p<0.001). Conclusions:We demonstrated that infiltration of lidocaine with adrenaline has statistically and clinically better impact on systemic haemodynamics and visibility of the surgical field than that achieved by topical application of ephedrine alone

The effect of injection speed on haemodynamic changes immediate after lidocaine/adrenaline infiltration of nasal submucosa under general anaesthesia

Background and Purpose: Substantial systemic absorption after adrenaline-containing local anaesthetic infiltration can cause transitional changes in heart rate and arterial blood pressure in humans even during general anaesthesia. The aim of this study was to determine the effect of injection speed of local infiltration of adrenaline- containing lidocaine solution on transitional haemodynamic changes during local infiltration of nasal submucosa under general anaesthesia. Patients and Methods: A retrospective, comparative, non-randomised, open study on 1–2 ASA physical status 83 patients, aged 18 to 81 years, scheduled for septoplasty, septorhinoplasty, classical or functional endoscopic sinus surgery was performed. All patients received the submucosal infiltration of 2%lidocaine containing adrenaline solution (2ml) plus adrenaline (0.025 mg) plus plain 2% lidocaine solution (5ml) before surgical incision. Two different infiltration techniques were identified: fast infiltration (Group F, n=40) and slower, incremental infiltation (Group S, n=43). Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) were recorded before, five minutes after and ten minutes after infiltration. Results: There was no significant difference in HR, SAP,DAP nor MAP between the F group and the S group. There was significant decrease of HR (p=0.006), SAP (p=0.018), DAP (p=0.029), and MAP (p=0.010) at 10 minutes point within the S group compared to baseline. There was significant decrease of HR (p=0.04) at the 10 minutes point within the F group compared to baseline. Conclusions: This study did not confimed that the speed of injection of lidocaine with adrenaline made any effect on haemodynamic changes during local infiltration of nasal submucosa.However it confirmed that lidocaine with adrenaline induced a decrease of blood pressure

The effect of injection speed on haemodynamic changes immediate after lidocaine/adrenaline infiltration of nasal submucosa under general anaesthesia

Background and Purpose: Substantial systemic absorption after adrenaline-containing local anaesthetic infiltration can cause transitional changes in heart rate and arterial blood pressure in humans even during general anaesthesia. The aim of this study was to determine the effect of injection speed of local infiltration of adrenaline- containing lidocaine solution on transitional haemodynamic changes during local infiltration of nasal submucosa under general anaesthesia. Patients and Methods: A retrospective, comparative, non-randomised, open study on 1–2 ASA physical status 83 patients, aged 18 to 81 years, scheduled for septoplasty, septorhinoplasty, classical or functional endoscopic sinus surgery was performed. All patients received the submucosal infiltration of 2%lidocaine containing adrenaline solution (2ml) plus adrenaline (0.025 mg) plus plain 2% lidocaine solution (5ml) before surgical incision. Two different infiltration techniques were identified: fast infiltration (Group F, n=40) and slower, incremental infiltation (Group S, n=43). Heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP) were recorded before, five minutes after and ten minutes after infiltration. Results: There was no significant difference in HR, SAP,DAP nor MAP between the F group and the S group. There was significant decrease of HR (p=0.006), SAP (p=0.018), DAP (p=0.029), and MAP (p=0.010) at 10 minutes point within the S group compared to baseline. There was significant decrease of HR (p=0.04) at the 10 minutes point within the F group compared to baseline. Conclusions: This study did not confimed that the speed of injection of lidocaine with adrenaline made any effect on haemodynamic changes during local infiltration of nasal submucosa.However it confirmed that lidocaine with adrenaline induced a decrease of blood pressure