Influencia de la existencia de una dehiscencia en un canal semicircular en el espesor óseo de los canales contralaterales

ObjectivesOur objective was to determine if the existence of dehiscence in the superior or posterior semicircular canal was associated with the thinning of the bone roof in the rest of the vertical canals (superior or posterior).MethodsThe thickness of the superior and posterior semicircular canals contralateral to a dehiscence was studied using computerized tomography and compared statistically.ResultsWhen a superior semicircular canal had a dehiscence, the contralateral canal showed a significant mean decrease in its thickness of 0.5 mm (SD: 0.3 mm). This was not the case if the dehiscence was in the posterior semicircular canal, where the thickness of 2.1 mm remained unchanged (SD: 1.2 mm; P=.49).When a posterior semicircular canal showed dehiscence, no significant thinning was shown in the superior semicircular (1 mm; SD: 0.4) or in the posterior contralateral (1.3 mm; SD: 0.3) canals.ConclusionThe existence of a dehiscence in the superior semicircular canal is associated with bone thinning in the canal on the opposite side, but not with the posterior semicircular canal. In contrast, if the dehiscence is in the posterior semicircular canal, contralateral and superior canal thickness is not modified.     

Mortalidad en el cáncer de laringe en estadios avanzados

Patients with advanced laryngeal carcinoma present a high mortality rate due to locoregional recurrence, distant metastases and second cancer. We present a report about the most important prognostic factors in mortality in patients included in III and IV stages. The most importants are the presence of metastatic lymph nodes (p=0.001), extracapsular spread (p=0.002) and N stage (p=0.005).     

Utilidad y versatilidad del colgajo en isla de la arteria supraclavicular en reconstrucción de cabeza y cuello

Introduction

The supraclavicular island flap is a rotational pedicled flap and may have some advantages in head and neck reconstruction compared with free-tissue transfer when this kind of reconstruction is not affordable or recommended.

Cirugía de rescate en las recidivas locales del carcinoma de nasofaringe

Introduction and objectives

Chemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches.

Resultados de un protocolo de preservación de órgano en pacientes con tumores localmente avanzados de la laringe

Introduction and objectivesAdvanced laryngeal carcinoma patients, candidates for total laryngectomy, nowadays have different treatment options. One of them is induction chemotherapy, which allows modulation of the second manoeuvre according to the degree of response achieved. This study presents the results of a large series of patients treated according to this protocol.MethodsRetrospective study of 370 patients with T3-T4 carcinomas of the larynx considered as candidates for total laryngectomy. All patients were treated with the protocol mentioned above.ResultsSeven patients died as a consequence of the treatment with chemotherapy. Among 363 patients finishing chemotherapy, 154 (43 %) achieved complete response and proceeded with radiotherapy. Total laryngectomy was performed in 135 (37 %) non-responders and 74 (20 %) patients were treated with radiotherapy in spite of an incomplete response to chemotherapy. Overall actuarial survival was 73 % at five years. Survival for patients with complete response and treated with radiotherapy was 77 % and for non-responders subjected to total laryngectomy it was 76 %. Non-responders treated with radiotherapy had a 5-year survival rate of 64 %, significantly different to both other groups (p = 0.01). Larynx preservation was achieved in 42 % of the patients, rising to 72 % for complete responders to chemotherapy and to 62 % in non-responders receiving radiotherapy.ConclusionsOur larynx preservation protocol including induction chemotherapy for patients with advanced carcinomas who are candidates for total laryngectomy achieved a total survival rate of 73 % with a 42 % larynx preservation rate. The response to the induction chemotherapy was the factor contributing most to larynx preservation.     

Experiencia de 20 años en el tratamiento microquirúrgico de la atresia de coanas

Introduction and objectivesChoanal atresia is the most common congenital nasal anomaly. Diagnosis is confirmed by endoscopic examination and computed tomography. The definitive treatment is surgical, and different surgical techniques and approaches are used. We describe our experience in transnasal microsurgical treatment of congenital choanal atresia.MethodsWe retrospectively evaluated 49 patients with congenital choanal atresia operated in the Department of Respiratory Endoscopy over a period of 20 years. The clinical variables analysed were type of atretic plate, age at diagnosis and surgery, associated malformations, maternal history of hyperthyroidism treated with methimazole during pregnancy, mode of airway stabilisation before surgery, surgical technique, complications, and outcome.ResultsMixed bilateral choanal atresia was the most frequent (29 cases). Its incidence was higher in females (61.2%). Almost 51% of patients showed associated malformations, and 7 had a history of maternal hyperthyroidism treated with methimazole during pregnancy. The surgical procedure consisted of a transnasal microscopic approach and placement of a silicone endonasal stent for one to 12 weeks. Thirty-five patients required revision after surgery. Nine patients had complications. Suitable nasal ventilation was achieved in 46 patients (93.9%). One patient died of causes unrelated to the surgery. Two patients with permeable choanae remain with tracheotomy.ConclusionThe transnasal microsurgical repair with endonasal stent proved to be a safe and effective procedure.     

Prevalencia de alteraciones en el complejo estilohioideo y tonsilolitos en la tomografía computarizada de haz cónico realizada en individuos con fisura labiopalatina

Introduction and objectives

Tonsilloliths and abnormal stylohyoid complex may have similar symptoms to others of different aetiology. Individuals with cleft lip and palate describe similar symptoms because of the anatomical implications that are peculiar to this anomaly. The aim of this study was to determine the prevalence of abnormal stylohyoid complex and tonsilloliths on cone beam computed tomography in individuals with cleft lip and palate.

Integración de la cirugía endoscópica en una unidad de base de cráneo: experiencia en los primeros 72 casos

IntroductionA multidisciplinary team is essential to develop and expand the indications in endonasal endoscopic skull base surgery.The aim of this study was to present our experience in a group of patients with skull base lesions treated using endonasal endoscopic approach.MethodsFrom January 2008 to January 2012, 72 patients with skull base involvement were diagnosed and treated in our centre.ResultsThe mean patient age was 53 years. The different pathologies included 36 pituitary adenomas, 10 cerebrospinal fluid leaks and 5 inverted papillomas as the most frequent pathologies. We performed a transsphenoidal transellar approach in 45 cases, a transmaxillary transpterygoid approach in 4 cases and a transnasal expanded approach in 6 cases. We performed an ethmoidal/sphenoidal approach in 12 patients and a Draf IIb/III procedure in four cases. Total resection was achieved in 61% of patients with pituitary adenomas, subtotal in 22% and partial in 17%. Successful repair was achieved in 86% of CSF leaks. No recurrences were observed in patients with inverted papilloma. Complications were observed in 21 patients (29%), 6 being major complications.ConclusionsOur centre stresses the importance of multidisciplinary collaboration in endoscopic endonasal skull base surgery.     

Eficacia de las maniobras de reposicionamiento canalicular en el vértigo posicional paroxístico benigno: revisión de 176 casos tratados en un centro hospitalario de tercer nivel

Introduction and objectives

Benign paroxysmal positional vertigo is the most common peripheral vertigo disease. The aim of this paper is to review the results obtained with the different specific particle repositioning manoeuvres, evaluating the possible risk factors linked to a poorer prognosis.

Encuesta sobre el conocimiento en la indicación de implantes cocleares para el tratamiento de la hipoacusia en España

Introduction

This study aims to analyse the knowledge of cochlear implant (CI) candidacy criteria of otorhinolaryngology specialists in Spain, and from the results, consider whether it is necessary to implement training measures aimed at improving knowledge in this area.

Preservación de órgano en pacientes con tumores avanzados de laringe. Resultados de la quimioterapia de inducción versus quimio-radioterapia en la práctica clínica real

Introduction and objectivesA high percentage of patients with locally advanced larynx carcinomas are candidates for inclusion in organ preservation protocols. The objective of this study is to compare the results of two schemes of preservation, induction chemotherapy versus chemoradiotherapy, in patients with locally advanced larynx carcinomas in the context of actual clinical practice.MethodsOur retrospective study included 157 patients with locally advanced tumours of the larynx (T3-T4) treated with induction chemotherapy (n = 121) or chemoradiotherapy (n = 36).ResultsFrom 121 patients who began treatment with induction chemotherapy, 6 died due to toxicity, 37 were treated with surgery, and 78 completed the preservation scheme; 36 patients received treatment with chemoradiotherapy. There were no significant differences in 5-year disease-specific survival between both treatments: 68.9% in induction chemotherapy versus 75.7% in chemoradiotherapy (p = 0.259). In 45.9% of patients the laryngeal function was preserved. Patients treated with chemoradiotherapy had a tendency to have better 5-year laryngeal dysfunction-free survival than patients treated with induction chemotherapy (55.6% versus 44.8%, p = 0.079).ConclusionPatients included in a protocol of organ preservation achieved a 5-year laryngeal dysfunction-free survival of 45.9%. There were no significant differences in disease-specific survival among patients treated with induction chemotherapy or chemoradiotherapy.     

Tratamiento de la ingestión de cuerpos extraños en una unidad de urgencias de otorrinolaringología: estudio prospectivo de 204 casos

AimsTo determine how often ingested foreign bodies are found and what parameters may predict their retrieval.MethodsDuring 1 year, we prospectively studied all patients referred to our Ear Nose and Throat Emergency Unit because of foreign body ingestion.ResultsDuring the study, 204 (median age-42 years [10 months-84 years]) patients were admitted because of ingested foreign body. The most common was fish bone (88%). Most patients were admitted <24-hour after ingestion (72%) and complained of symptoms above the cricoid cartilage (79%). A foreign body was removed by Ear Nose and Throat team in 108 (53%) patients. Twenty-three (11%) patients were referred to Gastroenterology. In 9 (39%) of these patients, a foreign body was identified by esophagogastroscopy, always from the esophagus. Predictive variables for retrieval of foreign body by Ear Nose and Throat team were ingested fish bone (P=.000; odds ratio [OR] = 17.3), short duration (<6 hours) of symptoms (P=.001; OR = 2.3) and symptoms above or at the level of cricoid cartilage (P=.000; OR = 8.9). In patients with symptoms below the cricoid cartilage the rate of retrieval of foreign body by Ear Nose and Throat team (11%) was significantly increased by Gastroenterology (41%; P=.03).ConclusionsPatients with ingestion of foreign body who ingest fish bone, present within the first 6 hours or complain of symptoms at or above cricoid cartilage deserve greater investment in terms of time and resources for retrieval of ingested foreign body by Ear Nose and Throat team.     

Importancia de la impedanciometría dentro de un programa de screening auditivo con otoemisiones en niños

The target of this paper is to evaluate the importance of Impedanciometry in a protocol with transient evoked otoacoustic emissions on high risk infant hearing screening. We used tympanometry and stapedious reflex only when otoacoustic emissions became altered. This method try to decrease the impact in this test caused for middle ear diseases. We realized an Impedanciometry study in all children with abnormal otoacoustic responses and then, we obtained normal otoacoustic responses when tympanometry normalize. In the other hand, the time of test wasn’t too large, between 15-20 minutes for child. The analysis of specificity and positive predictive value, of otoacoustic emissions without Impedanciometry was 89% and 45% respectively, however the same values with Impedanciometry was 96% and 75% respectively. In our opinion, high frequency of middle ear diseases in children, and our results, justify the introduction of Impedanciometry in a complete protocol of hearing screening with Otoacoustic Emissions, preventing appearance of false positive caused by these diseases.     

Aplicación de la biopsia por endoscopia flexible en el diagnóstico de la patología tumoral en otorrinolaringología

Introduction and objectives

Interventional endoscopy allows us to act on the pathology of the patient with minimal discomfort, low costs and high efficiency. We assessed the validity of flexible endoscopic biopsies in our hospital, in lesions suspected of malignancy in the rhino-pharyngo-laryngeal space.

Proliferación celular en tumores de glándulas salivales

Previous studies on cell proliferation in salivary gland tumors have shown the utility of immunostain with MIB1 in the differential diagnosis and prognosis of these neoplasms. We have carried out a study of 39 salivary gland tumors (17 benign), from different histological lineages. The immunocytochemical method used was the streptavidin – biotin – peroxidase complex which used the MIB1 monoclonal antibody. Benign tumors showed a low cell proliferation rates, below 5% with an overall average of 1.9%. The malignant tumors presented higher rates, with a middle value of 17.85%. Epidermoid carcinomas had the higher cell proliferation rates, with an average of 43%. In adenoid cystic carcinomas, we have observed that proliferation was greater at the peripheral level of tumor nests and cells surrounding the cystic structures. Neoplasms of low grade of malignancy presented lower cell proliferation rates. The MIB1 immunostain allowed to reach a differential diagnosis between pleomorphic adenoma and adenoid cystic carcinoma, specially in those cases in which there could be any doubt.     

Programas de detección precoz de la hipoacusia infantil en España: estado de la cuestión

Introduction and objectiveIn 2003, The Ministry of Health and Consumption, together with the Autonomous Communities (CCAA), approved a minimum and basic document concerning the establishment of Early Hearing Detection and Intervention State Programmes. Since then, the Commission for the early detection of hearing loss (CODEPEH) has made several updates and recommendations to improve these programmes.The objective of this study is to carry out a comparative analysis of how the CCAA established their Early Hearing Detection and Intervention programs and if they integrate the recommendations made by CODEPEH until 2017.Material and methodThe programmes (or related documents) of 16 CCAA available on line or paper are reviewedResultsThe 16 Early Hearing Detection and Intervention strategies analyzed are different, either in the number of test to be performed, the time in which they are performed or the techniques used. More than a third of these programmes were published before 2010 and have not been updated. Otoacoustic emissions is the chosen technique as the first screening test in nine of the 16 CCAA. Only one CCAA incorporates the salivary polymerase chain reaction test for cytomegalovirus in children with altered screening test.ConclusionAll CCAA perform Early Hearing Detection and Intervention programmes but the heterogeneity does not allow drawing reliable conclusions about the result of the screening process and it would be necessary to aim for unification with the elaboration of a national programme and an integrated general database.     

El papel actual de la cirugía parcial como estrategia de preservación funcional en el carcinoma de laringe

With the current advances and recent organ preservation protocols for intermediate or advanced stage laryngeal cancer, based on chemotherapy, the role of surgery seemed replaced except for surgical rescue of tumours not responding to these treatments, total laryngectomy being the surgical option. This type of non-surgical treatment is offered as a strategy for organ preservation, as opposed to total laryngectomy. However, we believe that there are two organ-preservation strategies, surgical and non-surgical. A wide spectrum of surgical techniques is available and such techniques lead to excellent results, both oncological and functional (speech and swallowing). The aim of this paper is to present options for organ-preserving surgery for laryngeal cancer. A review of surgical techniques available for functional preservation in cancer of the larynx at intermediate or advanced stage is presented. In addition to classic approaches such as vertical partial laryngectomy and horizontal or supraglottic laryngectomy, options for conservative laryngeal surgery have improved significantly over the past two decades. Minimally invasive surgery, transoral laser surgery, and supracricoid partial laryngectomy have become important laryngeal preservation approaches for patients with laryngeal cancer. Surgery must define its role in the multidisciplinary treatment of advanced cancers of the larynx, which at present often favours (chemo)radiotherapy protocols.     

Factores perinatales que influyen en la detección de otoemisiones acústicas en recién nacidos sanos,por parto vaginal,en las primeras 48 horas de vida

Introduction and objectivesMost hospitals perform neonatal hearing screening because it is a very useful procedure. Otoacoustic emissions are an ideal technique for this screening. We analyse the possible influence on screening results of some perinatal factors.Materials and methodsWe collected retrospective data from 8,239 healthy newborns delivered vaginally at the maternity ward of our hospital. We compared multiple perinatal factors vs the results of otoacoustic emissions performed within the first 48 h of life, before discharge.ResultsA total of 6.4% of newborns had an abnormal response and failed the screening. Univariate and multivariate analysis showed a significant (P<.0001) positive relationship between breastfeeding and normal otoacoustic emissions (OR: 0.65). Another, less significant factor was female gender. The remaining variables, including origin, education or employment status of the mother, maternal smoking, dystocic delivery, presentation, need for resuscitation, preterm labour (34-36 weeks), weight, length and frequent maternal pathology, such as streptococcus detection, hypothyroidism, hypertension or diabetes, were not significant.ConclusionsBreastfeeding was the most important factor related to a normal response in otoacoustic emissions. It may improve final results and reduce the number of neonates who need to be rescheduled for a repeated test, as well as the associated anxiety and the possibility of losing patients during follow-up. These are major problems in neonatal hearing screening.