Implantes activos de oído medio

Active middle ear implants are surgically implanted prosthesis, which intend to stimulate the ossicular chain or the inner ear fluids through the oval or round windows. These implants may be useful for the treatment of certain patients with sensorineural hearing loss as well as for conductive or mixed hearing loss. This clinical guide attempts to summarize the current knowledge concerning the basic characteristics and indications of the most commonly used middle ear implants, including Vibrant Soundbrige (Med-el, Innsbruck), Carina (Cochlear, Australia), and Codacs^TM. (Cochlear, Australia).     

Significación clínica de la asimetría amigdalina

IntroductionAsymptomatic unilateral tonsillar enlargement is usually treated with systematic tonsillectomy under suspicion of malignancy. Due to the fact that most of the cases are benign pathologies, we set out to study the clinical signs that would help us in the diagnosis in order to avoid unnecessary tonsillectomies.Material and methodsWe reviewed 267 tonsillectomies performed from 1996 to 2006 and 30 of these were indicated because of asymmetry. We evaluated risk factors for malignancy: cervical lymphatic node enlargement, sex, age, tonsillar enlargement noticed by the patient, suspicious appearance, systemic symptoms, history of malignancy and immunocompromise.ResultsHistopathologic study revealed 80 % to be benign and 20 % malignant. The risk factors with the strongest association were enlargement of cervical lymphatic nodes and suspicious appearance of the tonsil.ConclusionsStrict control of a unilateral tonsillar enlargement is possible, but it is mandatory to perform a tonsillectomy when the appearance of the tonsil raises suspicions or there are enlarged lymphatic nodes.     

Implicación clínica de la lesión iatrogénica de la cuerda del tímpano en la cirugía de la otosclerosis

Introduction: Damage to the chorda tympani nerve is frequent during otologic surgery. This article studies the clinical outcomes of the nerve's section versus its conservation in otosclerosis surgery.Material and method: Retrospective observational study using our department's otosclerosis database and a validated questionnaire on symptoms associated with the chorda tympani nerve. The sample was divided into two groups: section and conservation (patients whose nerve was anatomically conserved). We studied the presence and duration of symptoms, the surgical technique and the audiometric results.Results: 78 patients (88 ears): section group (18 ears; 20 %) and conservation group (70 ears; 80 %). Overall, gustatory symptoms appear in 35 % (39 % section group; 34 % conservation group). Differences between groups are not statistically significant in relation to presence and duration of symptoms, surgical technique or audiometric results. Only 1 patient in each group reports long-term symptoms. Our results suggest there are no major clinical differences following section versus conservation of the chorda tympani nerve. A wide range of factors such as age, presence of previous middle ear pathology, cross innervation and gastronomic culture may play a role in the appearance of symptoms.Conclusions: Symptoms appearing after iatrogenic damage to the chorda tympani nerve have, in general, little clinical relevance, especially in the long term, regardless of whether the nerve is dissected or manipulated to various degrees.     

Manejo de las fístulas nasales de líquido cefalorraquídeo según su tamaño. Nuestra experiencia

ObjectiveWe present our experience in the reconstruction of cerebrospinal fluid (CSF) leaks according to their size and location.Material and methodsFifty-four patients who underwent advanced skull base surgery (large defects) and 62 patients with CSF leaks of different origin (small and medium-sized defects) were included. Large defects were reconstructed with a nasoseptal pedicled flap positioned on fat and fascia lata and lumbar drainage was used. In small and medium-sized leaks of other origin, intrathecal fluorescein 5% was applied previously to identify the defect. Fascia lata in an underlay position was used for reconstruction, which was then covered with mucoperiosteum from the turbinate. Perioperative antibiotics were administered for 5-7 days. Nasal packing was removed after 24-48 hours.ResultsThe most frequent aetiology for small and medium-sized defects was spontaneous (48.4%), followed by trauma (24.2%), iatrogenic (5%) and others. The success rate was of 91% after the first surgery and 98% in large skull base defects and small/medium-sized respectively. After rescue surgery, the rate of closure achieved was 100%. The follow-up was 15.6 ± 12.4 months for large defects and 75.3 ± 51.3 months for small/medium-sized defects without recurrence.ConclusionsEndoscopic surgery for closure of any type of skull base defect is the gold standard approach. Defect size does not play a significant role in the success rate. Fascia lata and mucoperiosteum allow a reconstruction of small/medium-sized defects. For larger skull base defects, a combination of fat, fascia lata and nasoseptal pedicled flaps provide a successful reconstruction.     

Miotomía del cricofaríngeo en el tratamiento de la distrofia muscular oculofaríngea

Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant myopathic disease which provokes oropharyngeal dysphagia, palpabral ptosis and proximal limb weakness. It is the abnormal expression of the GCG triplet in the PABPN1 gene on chromosome 14 that causes this disease. The study of the oropharyngeal dysphagia that these patients suffer from should include upper gastrointestinal endoscopy, barium video-radiology and oesophageal manometry. Genetic study confirms the diagnosis. We report 6 patients (3 of whom were siblings) referred to our department with a confirmed diagnosis of OPMD, who underwent cricopharyngeal myotomy to achieve normal swallowing.     

Parálisis facial: guía de práctica clínica de la Sociedad Española de ORL

Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis. However, not all patients with facial paresis/paralysis have Bell's palsy. Other common causes include treatment of vestibular schwannoma, head and neck tumours, iatrogenic injuries, Herpes zoster, or trauma. The approach to each of these conditions varies widely. The purpose of this guideline is to provide clinicians with guidance on the treatment and monitoring of patients with different causes of facial paralysis. We intend to draft a practical guideline, focusing on operationalised recommendations deemed to be useful in the daily management of patients. This guideline was promoted by the Spanish Society of Otolaryngology and developed by a group of physicians with an interest in facial nerve disorders, including at least one physician from each Autonomous Community. In a question and answer format, it includes 56 relevant topics related to the facial nerve.     

Cirugía de implante de estimulador de nervio hipogloso en el síndrome de apnea obstructiva del sueño: nuestra experiencia preliminar

The objective of this communication is to describe our preliminary results in upper airway stimulation surgery via hypoglossal nerve stimulation implantation for obstructive sleep apnoea. We describe 4 cases and the outcomes of the surgery were analysed using the Epworth scale, apnoea-hypopnoea index, minimal O₂ Sat, average O₂ Sat and snoring intensity. In all cases a significant reduction in Epworth scale values and apnoea-hypopnoea index were obtained (P<.05). The minimum and average oxygen saturation had better values after the surgery, however, there was no statistically significant difference. The snoring severity measured subjectively changed from «intense» to «absent» in all cases. The preliminary results obtained with the upper airway stimulation surgery via hypoglossal nerve stimulation showed objective and subjective improvement after the implant activation.     

Reconstrucción de defectos faríngeos

Reconstruction of pharyngeal defects continues to present a clinical challenge for the Head and Neck surgeon. We have different reconstructive options to preserve speech, airway and swallowing functions. Reconstructive surgery implies a balance between oncologic cure, patient morbidity and quality of life.Classical reconstructive techniques include pedicled cervical cutaneous or myocutaneous flaps and distal myocutaneous flaps such as from the pectoralis major. Current microvascular technique options have a differing incidence of complications but always with high success rates.This article reviews the most current options on reconstructive techniques in pharyngeal defects.     

Estudio no intervencionista de las alteraciones de la filtrabilidad sanguínea en el debut clínico de sorderas súbitas neurosensoriales

an hemorheological study on whole blood filterability (wbf) was done in eleven patients bearing of sudden deafness, in a continuous way, even before clinical onset. this evaluation is making usually in animal models, but not in humans. independently of clinical diagnosis of each patient (two cases of diabetes mellitus, one of ulcerative colitis, systemic lupus erythematosus, systemic hypertension, after blood transfusion, sepsis with disseminated intravascular coagulation, upper respiratory ways infection, after surgery, and two healthy individuals), all of them showed a decresed wbf when hearing loss appeared (from 19,97±1,15 ?l/sec to 16,87±1,21 ?l/sec). this value normalized at six or seven days from the onset in cases with some kind of hearing recovery (18,83±1,01 ?l/sec, n=4), but did not in those with no improvement even at thirty days (17,39±0,77 ?l/sec, n=7). there were differences in wbf values of patients with and without hearing recovery in determinations at seven and thirty days from onset. decrease in wbf accompanies this hearing disorder and confirms the cochlear microcirculation susceptibility to the impairment of blood viscoelastic properties     

Estrategias para la práctica de la otorrinolaringología y cirugía de cabeza y cuello durante la fase de control de la COVID-19

The appearance of a new coronavirus disease called COVID-19 at the end of 2019 and its pandemic expansion in the world has changed the usual practice of the specialty of Otorhinolaryngology (ENT). After a phase of exponential growth of infections, it has been possible to enter a phase of control of the spread of the disease in which the possibility of infection persists, and the appearance of new cases is considered acceptable by the health system.The aim of this document is to review the available evidence and propose strategies and recommendations for the medical-surgical practice of otorhinolaryngology and head and neck surgery, which allow establishing the usual activity, adapting the safety and efficacy standards to the current situation. Therefore, it is required to identify and classify patients according to criteria of infectious-immunological status, and to establish recommendations for protection in consultations, hospitalization and the operating room, which avoid the transmission of the disease to other users and healthcare personnel, in the specific context of the development of our specialty. This document is the result of the collaboration of all the scientific commissions and the SEORLCCC COVID-19 committee.     

Asociación entre fístula de líquido cefalorraquídeo y persistencia del canal de Sternberg: ¿coincidencia o causa?

Endoscopic surgical techniques allow treating various pathological diseases of the cranial base, including cerebrospinal fluid leaks (CSF). These approaches have a high success rate and reduce surgical time and morbidity. However, when they are located in the lateral wall of the sphenoid, the surgery is more complex. In our case, the CSF appeared to be related with a Sternberg's canal. Predisposing factors were also associated with an extensive unilateral pneumatization of the sinus and benign intracranial hypertension. The closure of the leak was achieved using an endoscopic transethmoidal transpterygoid approach for proper exposition of the lateral wall of the sphenoid. After five years of monitoring, the patient has had no more episodes of rhinoliquorrhea.     

Expresión clínica de las alteraciones del equilibrio en pacientes con síndrome de latigazo cervical

Introduction and objectiveThere are many entities that cause equilibrium disorders. Whiplash syndrome is becoming an important entity as a trigger of equilibrium disorders because of an increase in traffic accidents. There are many hypotheses on the generation of vertigo and dizziness in whiplash syndrome. The objective of this study is to describe and analyze the clinical symptoms of patients who suffered whiplash.Material and methodThirty six patients with equilibrium disorders who suffered whiplash syndrome were studied prospectively. None of these subjects had cranial trauma or a history of vestibular pathology prior to the traffic accident. We conducted an exhaustive anamnesis, videonystagmography and cervical magnetic resonance. Patients were classified by type of equilibrium symptom and degree of cervical lesion.Results55.5 % of patients had a sensation of dizziness associated with postural and cephalic movements, 38.8 % had disequilibrium continuously, and 16.7 % (6 cases) had vertigo. Three of this last group had a diagnosis compatible with benign positional vertigo but this diagnosis was confirmed in only 2 patients; two patients had labyrinth commotion and one patient had vertigo of unknown origin.ConclusionsIn patients with whiplash, the most frequent equilibrium symptom is the sensation of fleeting dizziness associated with head movements, while only a small group suffer from vertigo. Although vestibular tests are normal in most patients, we cannot rule out the existence of otolithic lesions.     

Comparación de dos cuestionarios específicos de calidad de vida en población pediátrica con patología adenoamigdalar

Introduction and objectiveT-14 and TAHSI are validated and reliable specific questionnaires which measure the quality of life in paediatric patients with adenotonsillar disease. The present study aims to compare the adapted and validated versions in Spanish of these two questionnaires (T-14-s and s-TAHSI) in order to assess the preferential use of either of them in our environment.Material and MethodsA multicentre prospective cross-sectional study was carried out between November 2015 and April 2016, to determine the possible correlation between these two instruments. Subjects aged from 2 to 16 years with indication for adenotonsillar surgery and healthy controls, were consecutively included. Parents or caregivers of these children completed T-14-s and s-TAHSI questionnaires initially, after 2-6 weeks and at 6 months after surgery. T-14-s and s-TAHSI scores of the entire sample were compared globally, patient and control subgroups were compared separately and finally, compared in the group of patients at 6 months from surgery, using Pearson correlation coefficient. The proportion of variability shared between both tests was calculated.ResultsA hundred subjects (50 cases and 50 controls) were studied. The overall correlation presented by both questionnaires was very high (0.97) with a significance level of p < .01. The proportion of shared variability was 94%, very high. The results were maintained when comparing the questionnaires in the subpopulations of cases and controls, as well as the postoperative questionnaires.ConclusionQuality of life questionnaires for paediatric patients with adenotonsillar pathology, T-14-s and s-TAHSI, showed high correlation and allows the equivalent use of both in our environment.     

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.

Rehabilitación del paciente laringectomizado. Recomendaciones de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello

Total laryngectomy remains essential treatment for locally advanced laryngeal carcinoma, related to better survival rates. However, it involves changes for the patient, such as the inability to communicate verbally, breathing or aesthetic changes, which affect their quality of life and require comprehensive rehabilitation.This paper was written by the total laryngectomy rehabilitation workgroup of the National Head and Neck and Skull Base working committee of the Spanish Society of Otolaryngology and Head and Neck Surgery. The purpose of the article is to combine materials, surgical procedures and means towards the comprehensive rehabilitation of total laryngectomy patients, so that they can achieve a good quality of life. This paper is aimed at all health care professionals caring for total laryngectomy patients. It is also aimed at the patients themselves, as well as ENT surgeons.We have considered staffing and material needs, all procedures before, during and after surgery and after hospital discharge. There are also detailed recommendations about types of rehabilitation and follow-up, and the need for recording these events.The comprehensive rehabilitation total laryngectomy patients is very important if we want to improve their quality of life. The recommendations we mention aim to help the healthcare professionals involved in the treatment of total laryngectomy patients to help them achieve a good quality of life, as similar as possible to the life they led before surgery.     

Lista de verificación de tomografía computarizada de hueso temporal y base de cráneo lateral

Computed tomography scan of the temporal bone is a fundamental imaging modality for both the diagnosis and treatment of a wide range of pathologies affecting this complex structure. Temporal bone computed tomography scan provides a more detailed depiction of bone structures, compared with magnetic resonance imaging and, for this reason computed tomography scan is the imaging modality of choice in the planning of otological surgery.The aim of this article is to present a checklist to allow the otolaryngologist to assess systematically and in an organized manner the main anatomical landmarks, anatomical variants, as well as the most common postoperative surgical changes, which can be identified before any safe otological surgery.This revision was promoted by the Spanish Society of Otolaryngology and elaborated in a checklist template divided into the different areas of the temporal bone and the lateral skull base.     

Monitorización intraoperatoria del nervio facial durante la cirugía de la glándula parótida en servicios de otorrinolaringología - cirugía de cabeza y cuello

IntroductionFacial nerve injury remains the most severe complication of parotid gland surgery. Due to the increasing evidence about the advantage of the use of intraoperative facial nerve monitoring, a survey was distributed among members of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery with the objective of determining patterns of its use.Material and methodsA questionnaire which included 12 separate questions in 3 sections was distributed via email through the official email of the Spanish Society of Otorhinolaryngology-Head and Neck Surgery. The first section of questions was in relation to demographic characteristics, the second section was related to the pattern of monitoring use and the third section referred to litigation related to facial palsy.Results1544 anonymous questionnaires were emailed. 255 surveys were returned, giving an overall response rate of 16.5%. From these, 233 (91.3%) respondents perform parotid gland surgery. Two-hundred nineteen (94%) respondents use intraoperative facial nerve monitoring. Of the respondents,94% used intraoperative facial nerve monitoring if in their current practice they performed fewer than 10 parotidectomies per year and 93.8% if they performed more than 10 (OR, 1.02; 95% CI, 0.68-1.45; p = .991). With regard to lawsuits, just 3 (1.2%) of the respondents had a history of a parotid gland surgery–associated lawsuit and in just one case the facial nerve monitor was not used.ConclusionOur data demonstrate that most otolaryngologists in Spain use intraoperative facial nerve monitoring during parotid gland surgery. Almost all of them use it to improve patient safety and consider that facial nerve monitoring should be helpful preventing inadvertent injury.     

Recomendaciones de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello para la realización de traqueotomías en relación con pacientes infectados por coronavirus COVID-19

The recent COVID-19 (coronavirus) pandemic is causing an increase in the number of patients who, due to their pulmonary ventilatory status, may require orotracheal intubation. COVID-19 infection has demonstrated a high rate of transmissibility, especially via the respiratory tract and by droplet spread. The Spanish Society of Otolaryngology and Head and Neck Surgery, based on the article by Wei et al. of 2003 regarding tracheotomies performed due to severe acute respiratory syndrome (SARS), has made a series of recommendations for the safe performance of tracheotomies.