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JOSE R. REYES MEMORIAL MEDICAL CENTER DEPARTMENT OF OTOLARYNGOLOGY TITLE: NGTInducedSinusitis: A ProspectiveCohort Study AUTHORS: Wilfredo E Batol, MD FelicidadC. Felicilda,MD Gil M. Vicente,MD ABSTRACT: cations since, with the introduction of a polyvinyl tube into the nasal cavity, the sanctity of this natural A cohort study of 51 in-patient with NGT (Group orifice may have been violated. 1) at the Jose R. Reyes Memorial Medical Center was undertaken from October 1969 to August 1990 Linden et al in 1988 recognized sinusitis as a in order to determine the relationship of nasogastric complication of nasotracheal intubation. 7 With tube to the development of sinusitis. 50 in-patients tubes of larger diameter exactly filling up the nasal without NGT (Group 2) age and sex matched served cavity, nasal obstruction causing inflammation of the as control. 39 patients (76.47%) in Group 1 while ostiomeatal unit with subsequent poor 9,10,11 drain- 10 patients (20%) in Group 2 developed sinusitis within age of the paranasal sinuses- may reult to sinusitis. the minimum observation period of 14 days. There is a statistically significant difference between these But can a tube with a smaller diameter like two groups (p
PATIENTS & METHODS: These signs and symptoms are the typical triad of sinusitis as proposed by Stammberger & Wolf. it For a period of 11 months (October 1989 to August Patients underwent a second paranasal sinus x-ray 1990), all in-patients at the Jose R. Reyes Memorial soon as they manifest signs and symptoms of sinusitis. Medical Center in whom nasogastric intubation were However, if no signs and symptoms were noted, indicated were examined and evaluated. Prior repeat x-rays were done on the 7th and 15th day from to nasogastric intubation, complete history and ENT the time of observation. A minimum period of physical examinations which included anterior and 14 days observation was required. Comparison posterior rhinoscopy, otoscopy, oropharyngeal ex- of the initial and the succeeding paranasal sinus x- amination and indirect laryngoscopy were done. rays of the two groups were performed. (Figure 1) Initial x-ray of the paranasal sinuses (Waters, Cladweil & Lateral views) was performed. Patients were ex- A diagnosis of sinusitis was made if patients eluded according to the ioliowing criteria: showed: (a) at least two of the signs and symptoms 1. Those with prior history of acute or chronic previously mentioned sinusitis and allergic rhinitis. (b) if the films showed haziness of the parana- 2. Those patients whose initial sinus x-ray shows sal sinuses haziness of the paranasal sinuses. 3. Those with prior surgical treatment to the nose and paranasal sinuses. FIGURE1. METHODOLOGY 4. Those with prior history of trauma to the GROUP1 W/s/s->2ND nose and paranasal sinuses. / \/ PNSx_¥ 5. Those with tumors of the nose and paranasal In-patients --> HISTORY--> EXCLUSION } sinuses. P.E. CRITERIA \ }/\ 6. Patients below 15 yrs. of age. GROUP2 W/O$/S->XRAY 7. Pregnant patients. 7 OR14O 8. Uncooperative patients. Patients in whom nasogastric tube was indicated INITIAL PNS X-RAY and who did not belong to the exclusion criteria were included in this study. This set of patients were labeled Statistic',d analysis using Chi-square test with as Group 1. Yates correction was used in the evaluation of the data with p values less than 0.05 considered as A second set of patients admitted without NGT, significant. age and sex matched with the first group was likewise examined and evaluated. This set of patients was RESULTS: , labeled as Group 2. Exclusion criteria were also applied to this second set of patients. Patients who were Sixty eight patients with NGT were initially included had initial sinus x-rays. Daily complete included in this study. There were 17 drop-outs due ENT examinations were also done. to early removal of the NGT and because of early discharge from the hospital. Finally, fifty-one pa- In both groups, the occurence of foUowing tients who had NGT were included and labeled as signs and symptoms were evaluated: Group 1 while another 50 patients without NGT were labeled as Group 2 (age and sex-matched) for a 1. nasal obstruction or stuffiness total of one hundred and one patients. Group 1 had 30 males and 21 females, While Group 2 had 2. pathologic secretions (purulent, mucoid or 30 males and 20 females. The age range of Group serous discharge) 1 patients was 15 through 89 years, with a mean age of 41 years. The age range of Group 2 patients 3. headache or tenderness localized to the area was 17 to 84 years with a mean age of 39 years. of sinuses, Group 1 had 32 "(62.7%) patients with deviated nasal septum and 19 (373%) with midline nasal 40
Page 2 and 3: Iq4LIPl:qut=S TABLE OF CONTENTS NEC
Page 4 and 5: HEAD AND NECK SURGERY - TO ADD OR N
Page 6 and 7: PRESIDENT'S PAGE The years 1989-90
Page 8 and 9: RIZAL MEDICAL CENTER DEPARTMENT OF
Page 10: muscles. Again it is likely possibl
Page 15 and 16: area measuring 4.8 x 3.7 cm extendi
Page 17 and 18: tend to recur locally, even after p
Page 20 and 21: UNIVERSITY OF THE PHILIPPINES PHILI
Page 22 and 23: The majority of patients with hyper
Page 24 and 25: mass wa uttrasonograImy. Neck explo
Page 26 and 27: Figure 2 : Parathyroid Adcnoma vs.
Page 28 and 29: E.wa_ileMassonLe_Maxilla "salt& pep
Page 30 and 31: of some clinical features as well a
Page 34 and 35: MCU HOSPITAL DEPARTMENT OF OTOLARYN
Page 37 and 38: JOSE REYES MEMORIAL MEDICAL CENTER
Page 39 and 40: nonetheless stated: "We have the im
Page 41: to the diagnostic know-how of the c
Page 45 and 46: Most patients in group 1 complained
Page 47 and 48: DISCUSSION: and septal deviation mi
Page 49 and 50: OSPITAL NG MAYNILA DEPARTMENT OF OT
Page 51 and 52: ..temporary relief. According to Ha
Page 53 and 54: CASE REPORT phonuclear cells. The r
Page 55 and 56: TITLE:Cleft Lip Surgeryfor Rural Fi
Page 57 and 58: After intubation and the endoctrach
Page 59 and 60: BIBLIOGRAPHY Converse, J.M., Recons
Page 61 and 62: UNIVERSITY PHILIPPINE DEPARTMENT OF
Page 63 and 64: Table 3. Distribution of Organism b
Page 65 and 66: J BIBLIOGRAPHY Y MACKOWIAK, P.A., J
Page 67 and 68: Figure 3. SENSITIVITY PATTERN OF Pr
Page 69 and 70: Figure 3. Percent SENSITIVITY PATTE
Page 71 and 72: loradatine 10 mg/tabletgiven once a
Page 73 and 74: 1. Severity of Symptoms 3. Comparis
Page 75 and 76: -J;r,ceiving 40 mg of loratadine da
Page 79 and 80: : ' : _ : ::::::: : : i : ::
Page 81 and 82: These patients are new patients see
Page 83 and 84: - Table Vl Baseline Signs and Sympt
Page 85 and 86: The following Table VII will show t
Page 87 and 88: • 14.Drowsiness: None 30 2 4 10 2
Page 89 and 90: Actifed's side effect of drowsiness
Page 91 and 92: " to be packed with one type of pac
Page 93 and 94:
With regard to microbiology of nasa
Page 95 and 96:
TABLE 6: MANNER OF CONTROL OF REBLE
Page 97 and 98:
APPENDIX C MICROBIALGROWTH POTENTIA
Page 99 and 100:
EAST AVENUE MEDICAL CENTER DEPARTME
Page 101 and 102:
type (20%-30% of cases) varies from
Page 103 and 104:
TABLE Ii HistologicalClassification
Page 105 and 106:
THE LATERAL NASAL WALL IN FILIPINOS
Page 107 and 108:
MIDDLE MEATUS: Diameter of ostium:
Page 109 and 110:
.;4".,..:'.-" ............. '---.",
Page 111 and 112:
Figure 4. Variation in the location
Page 113 and 114:
This study presents variations with
Page 115:
ACKNOWLEDGMENT The authors would li
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