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Emergence agitation may occur after general anesthesia with volatile anesthetics in children. We designed this study to examine the emergence behavior of children undergoing ear-nose-throat surgery after sevoflurane induction and desflurane maintenance versus both sevoflurane induction and maintenance using a recently published Pediatric Anesthesia Emergence Delirium (PAED) scale. In 38 premedicated children aged 12 mo to 7 yr mask induction with sevoflurane was performed and they were randomly assigned to receive either sevoflurane (n = 19) or desflurane (n = 19) for maintenance of general anesthesia. Time to tracheal extubation, modified Aldrete score, emergence behavior, recovery complications, and pain scores were assessed. The PAED scale showed a significant advantage for desflurane (6 [0-15] versus 12 [2-20], maximum total score of 20 for severe agitation). Time to extubation was significantly shorter with desflurane than with sevoflurane (5.4 +/- 1.4 versus 13.4 +/- 1.8 min). The modified Aldrete score on arrival in the postanesthesia care unit (PACU) was significantly lower in children receiving sevoflurane for maintenance. Time to discharge from PACU to normal ward and the incidence of adverse effects were not significantly different between the groups. In conclusion, the use of desflurane for maintenance of anesthesia after sevoflurane induction in children is associated with less severe emergence agitation and faster emergence times.

Paraneoplastic syndromes are extremely rare in otolaryngology.However, they can significantly influence both the therapy and outcome of patients with oncologic disease. This report deals with two cases of paraneoplastic syndromes associated with malignant tumors of the head and neck region. A 45-year-old male presented with a polymyalgia rheumatica, which was identified as a synchronous feature of a hypopharyngeal carcinoma. The symptoms disappeared after successful surgical treatment of the carcinoma. No analogous report has been published as yet. As demonstrated in a second case of a 54-year-old male, leukocytosis can be paraneoplastically associated with a squamous cell carcinoma of the tongue. The international literature is reviewed in order to analyze the incidence of different paraneoplastic syndromes related to malignancies of the upper aerodigestive tract including the rare neuroendocrine oat cell carcinoma of the larynx.

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Since the last decade of the last century, surgical voice restoration with the use of voice prostheses has become a standard after total laryngectomy. About 80-90 % of the patients are capable to speak well or even very well with a voice prosthesis. Although severe complications have become rare since special pharynx protectors are in use for the implantation of the voice prostheses, minor problems are quite common. Primarily, these are frequent leakages through the prosthesis caused by fast wear and tear of the material and biofilms on the surface of the prosthesis, granulation tissue around the prosthesis, loss of the prosthesis with either aspiration or ingestion and migration or enlargement of the fistula. This paper explains the application of the most common kinds of voice prostheses and the management of the most frequent problems.