The COVID-19 pandemic has had a major impact in healthcare systems across the world, with many hospitals having to come up with protocols and measures to contain the spread of the virus. This affects various specialties' clinical practices in many ways. Since early 2020 in Singapore, the Department of Otorhinolaryngology at Tan Tock Seng Hospital had to rapidly adapt to this pandemic as we provided services to the main healthcare facility combating the virus in our country. We had to design new workflows and also remain flexible in view of the ever-changing situation. There are 6 important domains for an otolaryngology department or any clinical department in general to consider when making adjustments to their practices in an outbreak: (1) clinical work, (2) education, (3) research, (4) safety of patients and staff, (5) morale of medical staff and (6) pandemic frontline work. We hope that the sharing of our experiences and the lessons learnt will be useful for both our local and international colleagues.
Ambulatory Care ; Biomedical Research ; COVID-19/prevention & control* ; Delivery of Health Care/methods* ; Education, Medical ; Elective Surgical Procedures ; Health Workforce ; Humans ; Morale ; Otolaryngology/methods* ; Otorhinolaryngologic Surgical Procedures ; Personal Protective Equipment ; Personnel Staffing and Scheduling ; SARS-CoV-2 ; Singapore/epidemiology* ; Workflow

One case with metal crochet through external auditory meatus embedded stylomastoid foramen, preoperative found no paralysis, underwent temporal bone CT examination to assess the illness after emergency surgery to remove the foreign body, postoperative patients of peripheral facial paralysis, explore and summarize the clinical experience.
Ear Canal ; pathology ; Facial Paralysis ; surgery ; Foreign Bodies ; surgery ; Humans ; Metals ; Otorhinolaryngologic Surgical Procedures ; methods ; Temporal Bone

OBJECTIVE: To repair the postoperative tissue detect of the base of tongue cancer in advanced patients. METHOD: There were 30 patients of medium-high differentiation squamous cell carcinoma(SCC) included in this study. According to the TNM staging of AJCC 2002, there were 4 cases of T2N1M0, 7 of T3N1M0, 10 of T3N2M0, 4 of T4N1M0 and 5 of T4N2M0. Surgical approach of the primary lesion: 12 with transhyoidpharyngotomy approach and 18 with mandibulotomy approach. All cases accepted radiotherapy 4-6 weeks after surgery. RESULT: Twenty-five cases were reconstructed with pedicle pectoralis major myocutaneous flaps, and all them survived. Among them, 1 flap was partial split with surrounding tissue spontaneously, and another flap had partial tissue necrosis, however, both flaps grew well with dressing and other local treatment. Other 5 cases were reconstructed with free anterolateral myocutaneous flaps. Among them, 1 flap had partial tissue necrosis, but had a secondary healing after removing necrotic tissue via mouth approach. All 18 patients of larynx-preservation had tracheal tube pulled out. The 3-year survival rate was 68% and the local control rate was 87%. CONCLUSION Pedicle pectoralis major myocutaneous flaps and free anterolateral myocutaneous flaps were alternative donor area for repairing postoperative tissue defect of the base of tongue; The former was preferred, and the latter was concealed so as to be a kind of effective method, which need adept technique of microsurgery.
Carcinoma, Squamous Cell ; surgery ; Free Tissue Flaps ; Humans ; Larynx ; Myocutaneous Flap ; Neoplasm Staging ; Otorhinolaryngologic Surgical Procedures ; methods ; Reconstructive Surgical Procedures ; methods ; Survival Rate ; Tongue ; pathology ; surgery ; Tongue Neoplasms ; surgery

PURPOSE: To analyze the outcome of endoscopic sinus surgery (ESS) after preoperative systemic steroid (PSS) treatment for chronic rhinosinusitis (CRS) with nasal polyposis (NP) and to investigate and compare clinicopathological factors associated with the outcome. MATERIALS AND METHODS: We performed a retrospective chart review of 468 patients with CRS with NP who underwent primary ESS between January 2005 and October 2011. 124 patients who met the inclusion criteria were included. Beginning from 2008, our clinic administered steroid preoperatively in patients of CRS with NP, thus there were 84 patients with preoperative systemic steroid (PSS group) and another 40 patients without such regimen (no PSS group). To evaluate the outcome after ESS, poor outcome and complication were analyzed according to the following parameters: age, sex, follow-up duration, eosinophilic infiltration, atopy, asthma, Lund-Mackay score, and polyp grade. RESULTS: There was no significant difference in poor outcome rates between the PSS and no PSS group (35.0% vs. 47.6%, p=0.185). There was no significant difference in complication rates between the PSS and no PSS group (10% vs. 6%, p=0.468). As with the multivariate analysis of the clincopathological factors to the poor outcome rate, presence of asthma and eosinophilic infiltration were significantly related (odds ratio as 6.555 and 4.505, respectively), whereas PSS was confirmed as less likely related (odds ratio 0.611). CONCLUSION: Low dose PSS administration does not seem to have an effect on the outcome after ESS in patients who have CRS with NP. Eosinophilic infiltration and presence of asthma are important predictors of surgical outcome.
Adult ; Aged ; Asthma/complications ; Chronic Disease ; Endoscopy/*methods ; Female ; Humans ; Inflammation ; Male ; Middle Aged ; Nasal Polyps/complications/diagnosis/*surgery ; Odds Ratio ; Otorhinolaryngologic Surgical Procedures/*methods ; Paranasal Sinuses/pathology ; Prednisone/*administration & dosage ; Retrospective Studies ; Rhinitis/complications/diagnosis/*surgery ; Sinusitis/complications/diagnosis/*surgery ; Treatment Outcome

Adult ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Imaging, Three-Dimensional ; Male ; Maxillofacial Injuries ; diagnostic imaging ; surgery ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; methods ; Skull Fractures ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

OBJECTIVE: This study evaluates the effects of H-uvulopalatopharyngoplasty (H-UPPP) on endothelial function by endothelium dependent flow-mediated dilation(FMD) in patients with moderate to severe obstructive sleep apnea syndrome (OSAHS). METHOD: Forty-five healthy subjects and 49 patients with moderately to severe OSAHS who desired H-UPPP were prospectively enrolled. FMD was measured by high-resolution B-mode ultrasonography. All subjects participated in sleep studies. These studies were repeated 6 months after H-UPPP in patients with moderately to severe OSAHS. RESULT: There was significant difference in FMD between patients with moderately to severe OSAHS and healthy subjects at baseline (6.5 +/- 2.1)% vs (11.2 +/- 3.1)% (P < 0.01). FMD increased from (6.5 +/- 2.1)% to (9.7 +/- 2.7)% 6 months after H-UPPP in patients with moderately to severe OSAHS (P < 0.01). CONCLUSION FMD is decreased in patients with moderately to severe OSAHS, H-UPPP treatment of these patients leads to improvement of FMD.
Case-Control Studies ; Endothelium, Vascular ; physiology ; Humans ; Otorhinolaryngologic Surgical Procedures ; methods ; Palate ; surgery ; Pharynx ; physiology ; surgery ; Polysomnography ; Prospective Studies ; Sleep Apnea, Obstructive ; surgery ; Uvula ; surgery

OBJECTIVE: To investigate the efficacy and related factors of Z-palatoplasty for treating severe obstructive sleep apnea hypopnea syndrome (OSAHS). METHOD: Thirty-two severe OSAHS patients with Friedman II and III oropharyngeal airway had Z-palatoplasty. Twenty-three patients with modified Mallampti Index (MMI) III-IV had coblation tongue channeling (CTC) simultaneously. The patients were followed up for one year post operatively. RESULT: After operation, the apnea and hypopnea index (AHI) decreased from (54.74 +/- 20.38)/h to (22.72 +/- 18.36)/h; the lowest artery oxygen saturation (LSaO2 ) increased from (0.74 +/- 0.08) to (0.85 +/- 0.14); the Epworth sleep scale (ESS) decreased from (12.24 +/- 5.78) to (5.35 +/- 3.62); the percentage of time with oxyhemoglobin saturation below 0.90 (CT90) decreased from (31.48 +/- 20.15) to (15.73 +/- 12.29). All of the differences were statistically significant (P < 0.01). According to related criterion of chinese journal of otorhinolaryngology head and neck surgery in 2009, accumulative excellence rate was 71.9% and accumulative valid rate 84.4%. Six patients had temporary velopharyngeal insufficiency and returned to normal after 3 months. CONCLUSION Z-palatoplasty is an effective and safe surgical approach for OSAHS patients with Friedman II/III.
Adult ; Female ; Humans ; Male ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; methods ; Palate ; surgery ; Pharynx ; surgery ; Sleep Apnea, Obstructive ; surgery ; Treatment Outcome ; Uvula ; surgery

OBJECTIVE: To explore a new way to modify the UPPP and to assess the operative efficacy of modified-coblation assisted UPPP (M-CAUP) on patients with severe obstructive sleep apnea-hypopnea syndrome (OSAHS). METHOD: A retrospective analysis was made on surgical therapeutic effect of M-CAUP performed in our hospital. INCLUSION CRITERIA: 87 adult inpatients with severe OSAHS were involved in the study whose preoperative AHI were beyond 30/h and LSaO2 were under or equal to 85%. All those had the primary level obstruction within the retropalatal region as determined by PSG and airway pressure fluctuation monitoring (ApneaGraph 200, MRA-Medical Ltd, Gloucestershire UK) . The surgical approach of M-CAUP: (1) bilateral tonsillectomy by using Arthrocare EVac 70 T&A Wand. (2) dissection of velum palatinum space by using Arthrocare EVac 70 T&A Wand, ablation of fat tissue to removed it from the space, avoiding injure levator palatini muscle and tensor palatini muscle and preserving musculus uvula, maintaining the normal structure of oropharynx. (3) ablation of channel of soft palate by using Arthrocare EVac 55 T&A Wand to reduce the volume of soft palate moderately. (4) plasty: suturing the tonsilar fossa to close the space, interrupted suture two sides of palatine arch and uvula. All patients were followed up for six to eighteen months postoperatively and received PSG. RESULT: After M-CAUP, the pharyngeal cavity was enlarged while the basic structure of oropharynx was maintained and no nasopharyngeal refluxing occurred. The subjective symptoms were also improved evidently after operation. After operation, the AHI and Epworth sleepiness scale (ESS) decreased while LSaO2 increased. The reduction of AHI and ESS had statistical significance (P < 0.01), and the rise of LSaO2 also had statistical significance (P < 0.01). The total effective ratio of the operation was 89.7%. CONCLUSION Despite of various treatment, the operative efficacy of conventional UPPP was almost not ideal on severe OSAHS due to complex pathogeny. It was proved that M-CAUP was an effective surgical treatment of severe OSAHS with less blood loss. The operation was minimally invasive and maintained the normal functions of palatopharynx in principle. It could be applied in clinical practice.
Adult ; Female ; Humans ; Male ; Middle Aged ; Otorhinolaryngologic Surgical Procedures ; methods ; Palate, Soft ; surgery ; Pharynx ; surgery ; Retrospective Studies ; Sleep Apnea, Obstructive ; surgery ; Uvula ; surgery

OBJECTIVE: Analyzing the clinical manifestation, diagnosis and management of isolated sphenoiditis in children, retrospectively, was to get more information of the disease and to supply correct treatment early. METHOD: The symptoms, signs and imaging data of seventeen cases with isolated sphenoiditis hospitalized in our department from June 2001 to January 2010 were analyzed retrospectively. RESULT: Nine out of seventeen patients had the chief complaint of headache, three patients had blood in nasal discharge and had a fever, and five patients had postnasal drip with headache and a slight fever. The disease lasted for three months to one year. Five patients showed nasal discharge in rhinologic examination, one patient had solitary polyps in sphenoethmoid recess, eight patients had adenoid hypertrophy and the last three patients showed no positive signs. CT scan or MRI revealed opacification in sphenoid sinus. Eight patients received normative antibiotic therapy and were cured. The rest nine patients received endoscopic sinus surgery. The complaints relieved after the surgery and there was no signs of recurrence in 1 to 5 years of follow-up. CONCLUSION Headache can be the chief and unique symptom of isolated sphenoiditis in children, which was easy to misdiagnose and miss diagnosis. CT or MRI was the evidence of diagnosis. Antibiotic therapy could be used for acute sphenoiditis. Patients with chronic sphenoiditis should receive endoscopic sinus surgery as early as better. From supraturbinal to sphenoid sinus natural ostia is the best way in sphenoidotomy.
Adolescent ; Child ; Endoscopy ; Female ; Humans ; Male ; Otorhinolaryngologic Surgical Procedures ; methods ; Retrospective Studies ; Sphenoid Sinus ; pathology ; Sphenoid Sinusitis ; diagnosis ; pathology ; surgery

OBJECTIVE: To investigate the effect and clinical value of simultaneous multiple plane operations in treating severe OSAHS. METHOD: The clinical data of 93 patients with severe OSAHS were retrospectively analyzed. According to different obstruction plane, all the patients were performed different multiple planes of operations. Operations were finished in the same term. All patients underwent PSG examination before operation and 6-month, 1 year after surgical treatment separately. RESULT: No severe complication occurred. According to the assessment guidelines, the response rate was 100% in 6-month and 91.40% in 1-year respectively. CONCLUSION Most OSAHS have multi-level obstructions in upper airway caliber, such as nasal, nasopharyngeal, velo-pharyngeal and tongue-pharyngeal obstruction. Simultaneous multiple plane operations which based on multiple plane obstruction can improve curative effect.
Adult ; Apnea ; surgery ; Female ; Humans ; Male ; Middle Aged ; Nasopharynx ; surgery ; Nose ; surgery ; Otorhinolaryngologic Surgical Procedures ; methods ; Pharynx ; surgery ; Polysomnography ; Retrospective Studies ; Sleep Apnea, Obstructive ; physiopathology ; surgery ; Tongue ; surgery