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

Head and Neck Neoplasms ; surgery ; Humans ; Otorhinolaryngologic Surgical Procedures ; Quality of Life ; Reconstructive Surgical Procedures ; methods

Humans ; Otorhinolaryngologic Surgical Procedures ; methods ; Quinolones ; therapeutic use ; Respiratory System Agents ; therapeutic use

Academic Dissertations as Topic ; Humans ; Otolaryngology ; trends ; Otorhinolaryngologic Surgical Procedures ; methods ; Thyroidectomy ; methods