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Biomedical subjects

C B Croft

Publications and source records attributed to C B Croft.

At least 37 records · Page 2Linked to original sources
PubMed1991

A comparison of sleep nasendoscopy and the Muller manoeuvre.

Knowledge of the level of pharyngeal obstruction during sleep is an important factor in deciding whether or not a patient suffering from obstructive sleep apnoea syndrome (OSAS) will benefit from uvulopalatopharyngoplasty. The Muller manoeuvre has been advocated as a method of obtaining this information. We compared the findings from the technique of sleep nasendoscopy, which actually allows visualization of the level of obstruction in the sleeping patient, with the results of the Muller manoeuvre performed in the same patients while awake. We found the Muller manoeuvre to be less accurate than previously believed.

Airway Obstruction↗
PubMed1991

Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea.

It appears that uvulopalatopharyngoplasty (UVPP) is a reliable procedure for reducing snoring, but much less reliable when used as a treatment for OSAS. This is thought to be because of poor patient selection in that the site of the problem is not always the site of the operation. We present the technique of sleep nasendoscopy which allows direct visualization of the site or sites of obstruction in a sleeping patient. Our study has shown that there are patients with obstructive sleep apnoea syndrome (OSAS) in whom the only site of pharyngeal obstruction is at the velopharynx. These patients should do well with the relatively simple procedure of UVPP. This is not true for many other OSAS patients in whom we found that obstruction was multisegmental. This helps to explain the frequently poor results of UVPP in OSAS patients. We feel that this form of preoperative assessment will avoid unnecessary surgery.

Adult↗
PubMed1991

Polytomographic radiology in the diagnosis and management of maxillary antral disease as determined by antroscopy.

Plain radiology of the maxillary sinus correlates poorly with pathological conditions affecting it as shown by subsequent endoscopic assessment. Tomographic radiology provides a much higher diagnostic yield and in particular is of great value in assessing the 'opaque antrum'. The false positive rate is similar in the two techniques but tomography yielded no false negative diagnoses in this study compared with an incidence of 31% with plain radiology. Sinoscopy remains the definitive method of assessing antral disease but tomographic radiology is a highly accurate screening technique. It provides this accuracy at low cost, low orbital irradiation and more convenience than the newer techniques of CT and MRI scanning which are still not widely available for routine ENT use.

Adult↗
PubMed1991

Antroscopy in outpatient management: a prospective study.

Antroscopy has an established role in the diagnosis of maxillary sinus disease; however, its role in overall patient management requires clarification if it is to be widely adopted as an outpatient procedure. This study examined 100 consecutive attenders to an antroscopy clinic and monitored their diagnosis and management plan both before and after antroscopy. Diagnosis was altered or added to in 79% of cases and management in 73% of cases. The trend after knowledge of antroscopic findings was towards more medical treatment and less surgical intervention. Such a change would clearly have significant resource implications. While computed tomographic scanning time is limited, outpatient sinus endoscopy can be used as an intermediate investigation, with only selected patients going forward to be more comprehensively investigated.

Adolescent↗
PubMed1991

Sleep related upper airway obstruction in a cohort with Down's syndrome.

The prevalence of sleep related upper airway obstruction (UAO) was studied in a cohort of 34 children with Down's syndrome from a geographically defined area. Thirty two (94%) of the children, ranging in age between 0.1 and 4.9 years (median 1.4), underwent full clinical assessment for UAO including parental questionnaires and overnight tape recordings of chest wall movements and arterial oxygen saturation (SaO2). Compared with controls, children with Down's syndrome had (a) an increased incidence of stridor and chest wall recession during sleep, (b) an increased frequency of a pattern on inspiration indicating increased upper airway resistance, (c) a reduced baseline oxygen saturation (having excluded recordings on four children with potential for right to left intracardiac shunting), and (d) an increased number of episodes with SaO2 less than or equal to 90% despite continued chest wall movements. At their initial assessment seven children (22%) had evidence of UAO. The 18 youngest children (less than or equal to 1.7 years) underwent repeated recordings and clinical assessment until they had all reached 2 years of age. A further three were found to have developed UAO. Sleep related UAO is a common problem in children with Down's syndrome, occurring in 10 of 32 (31%) of this population based sample.

Airway Obstruction↗
PubMed1990

Uses and complications of uvulopalatopharyngoplasty.

Uvulopalatopharygoplasty has become widely performed for chronic snoring and for cases of obstructive sleep apnoea. Unfortunately this operation is not without morbidity and complications. We report our results of a prospective series of 50 patients undergoing uvulopalatopharyngoplasty with a minimum follow-up of one year. Snoring was abolished in 18 (36 per cent) and substantially reduced in the remainder. Obstructive sleep apnoea syndrome, identified in 11 patients pre-operatively, was reduced in severity in all but three. Troublesome complications were seen in 18 (36 per cent) patients, namely intermittent velopharyngeal incompetence in five (10 per cent), pharyngeal dryness in 11 (22 per cent) and loss of taste in five (10 per cent). One patient had nasopharyngeal stenosis requiring correction. A cautious approach to this operation is required with rigorous case selection. The importance of full assessment and careful follow-up should not be underestimated.

Adult↗
PubMed1990

Obstructive sleep apnoea in children undergoing routine tonsillectomy and adenoidectomy.

Sleep screening was used to discover the incidence of sleep apnoea in 50 children undergoing routine adenotonsillectomy for recurrent upper respiratory tract infections, randomly selected from the waiting list. Preoperative assessment included a detailed parental history, physical examination, and lateral cephalometry, in order to identify factors that might alert the clinician to a diagnosis of obstructive sleep apnoea. There were 2 equal groups of snorers and non-snorers (grade 0); 1 patient was found to have the sleep apnoea syndrome (IV), 9 patients had obstructive snoring with apnoeic episodes (III), 3 patients had snoring with a disrupted sleep pattern (II), and 12 patients snored with no disruption of sleep (I). In identifying patients with apnoea, a history of snoring was unhelpful, whereas one of breathing irregularities was found to be highly specific. Nasal obstruction correlated poorly; however, there was a significant relationship between tonsillar position and size and sleep grade (Chi-squared P less than 0.01). Stepwise regression analysis showed a large contribution to the grading was made by the size of the oropharyngeal airway measured by lateral cephalometry. The children in grade II-IV were re-studied 3 months post-operatively and all reverted to grades 0 or I.

Adenoidectomy↗
PubMed1990

Endoscopic evaluation and treatment of sleep-associated upper airway obstruction in infants and young children.

A method is described for observing the pharyngeal airway in children with proven sleep apnoea using a flexible nasendoscope during light anaesthesia. Fifteen children were referred for endoscopic evaluation and treatment. All had documented obstructive sleep apnoea. Flexible endoscopic assessment of the airway revealed the site of obstruction in all cases and allowed a rational and successful management plan. The mechanism of obstructive sleep apnoea in infants and young children is discussed and the findings at endoscopy and results of treatment are reported.

Adenoidectomy↗
PubMed1990

Non-infective orbital complications resulting from natural defects of the antral roof. Case report.

Infective complications of paranasal sinus disease presenting within the orbit are not uncommon. They may be facilitated by bony defects of the orbital floor or antral roof which may also allow non-infective complications to occur. These may occur spontaneously or may follow operative procedures upon the antrum and must therefore be borne in mind when performing such procedures. We present representative clinical examples of these non-infective complications.

Adult↗
PubMed1990

Assessment of chronic snorers.

Snorers represent a heterogenous group that require adequate assessment before recommending surgical treatment. There are unfortunately no specific features either in the history or physical examination that might predict those chronic snorers with obstructive sleep apnoea. We have used trained observation together with pulse oximetry ('sleep screening') and fibreoptic nasendoscopy with Muller manoeuvre in our unit to assess snorers. This combination is a reliable means of distinguishing apnoeic patients from simple snorers and determining the level of the obstructing segment. We report our experience in using these methods in the management of 71 chronic snorers. We stress the value of conservative management, and emphasize that obesity, habitual alcohol ingestion and nasal obstruction should be corrected before embarking on pharyngeal surgery.

Adult↗
PubMed1989

Detection of sleep associated dysfunctional pharyngeal obstruction in infants.

Six infants were referred with symptoms and clinical signs suggesting airway obstruction during sleep. In each case, overnight recordings of arterial oxygen saturation, respiratory movements and end tidal expired carbon dioxide (ETCO2) showed the presence of abnormal episodes of hypoxaemia related to partial or complete airway obstruction and associated with a specific pattern of the inspiratory movement waveforms. These events and patterns were not found on recordings from 20 age-matched healthy infants and young children. ETCO2 levels were also abnormally elevated in all six patients when asleep. Fiber-optic upper airway endoscopy excluded structural abnormalities, including significant tonsillar or adenoidal enlargement, but showed an intermittent dysfunctional inspiratory obstruction in the pharynx. Continuous positive airways pressure and tracheostomy were effective in treating this obstruction.

Airway Obstruction↗
PubMed1989

Antroscopy: current practice--a survey of UK otolaryngologists.

The use of antroscopy by otolaryngologists in the UK was assessed by means of a postal questionnaire. A response of 70 per cent was obtained. Thirty-three per cent of otolaryngologists currently perform antroscopy; the principal reason for not using the technique being lack of suitable equipment. Twenty-four per cent of non-users believed that antroscopy would not alter their management of patients, and 19 per cent of all responders thought that antroscopy had no proven clinical role. Few surgeons recognized a role for antroscopy in the treatment of antral disease. Antroscopists preferred to operate on in-patients (73 per cent), under a general anaesthetic (60 per cent) and via the inferior meatus (66 per cent); 76 per cent consider that morbidity is insignificant. There is clearly a need for studies clarifying the role of antroscopy in clinical practice and to establish the cost-effectiveness of the technique.

Endoscopy↗
PubMed1989

Symptomatic mucosal cysts of the maxillary sinus: antroscopic treatment.

Antroscopy has been shown to have a role in the diagnosis and treatment of antral disease. Four cases of 'non-secreting' benign antral cysts, each presenting with facial pain, were successfully treated using antroscopic techniques. The aetiology and management of these lesions is reviewed with the recommendation that antroscopic removal is the treatment of choice for all symptomatic cases, and for asymptomatic cases in which the diagnosis is in doubt.

Adult↗
PubMed1989

Wegener's granulomatosis, subglottic stenosis and antineutrophil cytoplasm antibodies.

Wegener's granulomatosis is difficult to diagnose, especially when the presentation is unusual, restricted to an isolated region. We report four cases of recurrent subglottic stenosis posing difficulty in diagnosis. In each case the finding of anti-neutrophil cytoplasm antibodies (ANCA) strongly suggested an underlying vasculitic pathology, Wegener's granulomatosis. We discuss reasons for the difficulty in diagnosis in the past, the possible role of the ANCA assay in such patients, and suggest it should be more widely used in the future.

Adult↗
PubMed1989

Antroscopy: a comparison between the sublabial (canine fossa) and intranasal (inferior meatus) approaches as an out-patient procedure.

We present a prospective randomized study comparing two approaches for out-patient antroscopy. The traditional inferior meatus route was seen to be associated with a higher incidence of discomfort and significant complications. An alternative route via the canine fossa provided easier access, better patient tolerance and improved visualization of the antral contents. It was associated with a lower incidence of immediate complications, although there were a number of delayed symptoms, all of which were mild and transient. The canine fossa approach under local anaesthesia offers an effective and more acceptable alternative for antroscopy as an out-patient procedure.

Adult↗
PubMed1989

Laryngeal papillomatosis: analysis of 113 patients.

Despite the low incidence of these diseases, both juvenile onset and adult onset laryngeal papillomatosis continue to concern otolaryngologists because treatment is often prolonged and unsatisfactory. Over many years various treatments have met with varied claims of success, yet no treatment today is universally accepted. We review the underlying clinical problems, the presentation, the treatment and eventual outcome of 113 patients seen at this hospital over the last 20 years with laryngeal papillomatosis. Using multivariate analysis of age at presentation, sex, smoking habits, initial site of disease, frequency of treatment and eventual outcome, two distinct patterns are revealed both between juvenile and adult onset disease and between male and female patients. Single-site lesions in adults have the best prognosis. Female children with multiple confluent lesions at presentation have the worst prognosis.

Adult↗