Cierre endoscópico de las perforaciones septales

Objective

The management of septal perforations is a challenge for the surgeon. A wide variety of surgical techniques have been described, with different approaches. There is no scientific evidence to support a particular approach. The objective of this review is to present a practical guide on the technique of choice for each case of septal perforation.

Abordaje combinado para el tratamiento de los encefaloceles temporales espontáneos: mastoidectomía + minicraneotomía

Spontaneous encephaloceles are defined as brain herniations with no apparent cause. The aim of this paper is to describe the surgical technique performed in our department.We reviewed the last 3 cases treated with combined approach (transmastoid plus minicraniotomy) with 2-layer closure.In all cases the bone defects were located and successfully sealed. We had no postoperative complications. There were no relapses in our follow-up period.The transmastoid approach has the advantage over the open approach with middle fossa craniotomy in that it locates the bone defect with no brain retraction. Nevertheless, it is not useful in large-sized, multiple or anterior defects. Due to those drawbacks, we think that the combined approach with temporal minicraniotomy is the best choice for this entity     

Tratamiento endoscópico combinado vs. abierto en el divertículo de Zenker

IntroductionZenker's diverticulum is a superior esophagus sphincter disease with a surgical management in symptomatic cases. This treatment has undergone important changes in recent years.Material and methodA retrospective review was carried out of 16 patients treated in our department between 2001 and 2008. Conventional open surgery was used as well as a combined endoscopic approach with stapler and CO₂ laser. Type of treatment, diverticulum size, operating time, oral feeding time, surgical complications, hospital stay and occurrence of relapses were analyzed.ResultsThe endoscopic approach was used in 8 patients, with a conversion to conventional open surgery being necessary in 2 cases. Operating time was of 90 min for the open approach and 45 in the endoscopic. Oral feeding could be reintroduced 36 hours after open surgery and 24 h after endoscopic treatment. The average discharge date was 3.8 days after the surgery in the open group and 2 days in the endoscopic group. Complications appeared in the 12.4% of the cases, all related to cervicotomy. There were 2 cases of relapse in the group treated with open surgery, one case was treated with the endoscopic approach and another with the open approach.ConclusionsThe combined endoscopic approach offers good results in patients with symptomatic Zenker's diverticulum who can be under general anesthesia during the surgery. A conversion to open surgery with cervicotomy should be done when a good endoscopic exposure is not possible.     

Particularidades del abordaje transcanal endoscópico de los tumores benignos de oído medio en adultos

Background and objectiveMinimally invasive surgery of benign middle ear tumours is possible by using the endoscope. The optimal lighting and the broadest vision it offers, allow a transcanal approach to these rare tumours. The objective of this work is to summarize its key points through a case series.Materials and methodsRetrospective study of benign middle ear tumours that underwent exclusive endoscopic surgery in a third-level adult university hospital between June 2018 and June 2020. Postoperative follow-up was performed by otoendoscopy and audiometry.ResultsSix patients underwent surgery during the study period. Five patients were female and one male, with an average age of 57.8 years (± 21.9). Four tumours were in the left ear and 2 in the right ear. These included 4 tympanic paragangliomas (3 type I and one type II), a chorda tympani neuroma, and a congenital cholesteatoma. There were no serious postoperative complications. At present, no tumour recurrence has been found in either case, with a minimum follow-up of 7 months.ConclusionsThe present study adds evidence on the safety and efficacy of endoscopic transcanal ear surgery, as a minimally invasive technique, for the treatment of benign middle ear tumours confined to the tympanic cavity.     

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.

Utilidad de la mucoplastia endonasal en el tratamiento quirúrgico de la rinosinusitis crónica con pólipos nasales. Estudio prospectivo

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with great impact on health. The surgical option using endoscopic sinus surgery is the therapeutic alternative when control of the disease is not achieved with medical treatment. Extensive endoscopic approaches are being postulated as a possible best surgical treatment option in certain phenotypes of CRSwNP. Endonasal mucoplasty associated with these approaches has been shown to be a complementary technique that improves both healing and mucosal edema in patients with CRSwNP in the short term. The aim of our study was to analyse the results of endonasal mucoplasty associated with a complete ethmoid-sphenoidotomy plus grade III frontal sinusotomy in the treatment of CRSwNP in the medium term. For this purpose, a prospective case-control study (10/10) was carried out on patients with CRSwNP. In the case group, endonasal mucoplasty in the left nostril was associated with surgery, and the control group was not. The assessment of quality of life at one year after surgery, as measured by the mean difference in SNOT-22 (mean [SD]), was significantly better in the case group than in the control group (45.9 [19.6]-26.6 [16.05] P = 0.027). The endoscopic improvement in healing and mucosal edema, measured by the Modified Lund-Kennedy scale, showed relevant improvements, when comparing both nostrils, but without reaching significance (P = 0.29). Endonasal mucoplasty promotes short-term healing, improving the quality of life in the medium term (one year) of patients treated with extensive endoscopic mucosal resections.     

Electromiografía laríngea en el diagnóstico y tratamiento de los trastornos de la voz

Introduction and objectivesLaryngeal electromyography, together with clinical evaluation, is a valuable tool in voice disorder management. It assesses the integrity of laryngeal nerves and muscles, contributing to the diagnosis of many diseases, especially laryngeal movement disorders. Our purpose was to describe the experience of the first Spanish series with laryngeal electromyography in evaluating voice disorders.MethodsA prospective study was designed to evaluate laryngeal movement disorders with laryngeal electromyography. Both the cricothyroid and thyroarytenoid muscles were tested routinely and, in some cases, the posterior cricoarytenoid muscle. The laryngeal electromyography technique and result interpretation were performed by a laryngologist and a neurophysiologist.ResultsWe included 110 patients, with the most common symptom being dysphonia. Laryngeal electromyography was performed in 85% of cases. Primary diagnosis before electromyography was laryngeal immobility. Positive predictive value for diagnosis in cases of paralysis was 88%.ConclusionsLaryngeal electromyography is a useful adjunct, together with clinical evaluation, for diagnosis and management of motion abnormalities in the larynx in patients who present with dysphonia.     

Faringoplastia de reposición modificada para el tratamiento del SAHS: cómo lo hacemos y nuestros resultados

Introduction and purposesThe relevance of the lateral pharyngeal walls in the collapse of the upper airway in obstructive sleep apnea patients has been revealed in the last 20 years. New surgical techniques that address this collapse have been published. The aim of this study is to show the technique that we are currently using to treat the collapse and its results.Materials and methodsThis is a retrospective study of surgically treated OSAS patients who did not tolerate conventional positive airway pressure (CPAP) or for whom it was not indicated. After a complete physical examination either awake or under drug-induced sleep endoscopy, tonsillectomy with reposition pharyngoplasty was performed using barbed bidirectional suture and removing the supratonsillar fat. Three to 6 months after surgery the subjective parameters were evaluated and a sleep study was performed.ResultsTwenty-six patients were enrolled with a significative decrease in the AHI and also significative improvement in all the rest parameters studied. In 65.4% of the patients the AHI decreased 50% and was lower than 20/h, in 42.3% postoperative AHI was lower than 10/h. The most frequent complication was the partial extrusion of the suture.ConclusionsThis surgical procedure obtains statistically significant results in objective and subjective parameters of sleep apnoea without major associated complications.     

Estudio comparativo entre sondajes lacrimonasales de primera intención con y sin control endoscópico

ObjectiveOur objective was to compare the results of probing with and without endoscopy in cases of congenital nasolacrimal duct obstruction without prior probing.MethodsThis was a retrospective analysis on 2 non-randomized cohorts, 36 simple soundings (group 1) and 36 soundings with endoscope (group 2), between January 2011 and January 2013. Both groups were similar in age and had no previous surgery. The age of the patients studied ranged between 8 and 27 months in the first group and between 7 and 30 months in the second group.ResultsThe procedure was successful in 50% of the conventional probing group and in 97.22% in the endoscopy probing group. In this group 16.67% of patients with tight inferior turbinate and 11.11% of those where the probe passed into the submucosal space were diagnosed and corrected intraoperatively. Some anomaly was observed in 30.56% of patients undergoing endoscopy.ConclusionAlthough nasal endoscopy is classically reserved for unsuccessful probing, its use in primary intention increases the success rate of the procedure. In our study, 97.22% of eyes had complete resolution of symptoms, avoiding a second surgery and the use of more expensive materials and techniques. Nasal endoscopy helps intraoperative visualisation, understanding and management of congenital nasolacrimal duct obstruction and is the only method that confirms the correct anatomic position of the catheterisation in real time.     

Concordancia interevaluador en la elección de tratamiento profiláctico para la migraña vestibular y papel de un algoritmo asistido para la elección de dicho tratamiento

Background and objectiveVestibular migraine (VM) is a cause of episodic vestibular syndrome. There are many drugs available for its prophylaxis and currently the choice is mainly made according to the patient's comorbidities. The aim of this article was to measure the agreement of a group of otorhinolaryngologists in the choice of a prophylactic treatment and to evaluate the role of an assisted algorithm in the choice of this prophylaxis.Material and methodThe medical records of 10 patients with VM were offered to 10 otolaryngologists who were asked to select for each patient the drug they considered most appropriate among five possible options. The Fleiss’ κ index was calculated among the 10 otolaryngologists alone, recalculating it including the algorithm as the eleventh evaluator, and Cohen's κ index was calculated between each otolaryngologist and the answers of the algorithm. The otolaryngologists were offered the option to change their responses after knowing the responses of the algorithm and then both indexes were calculated again.ResultsThe Fleiss’ κ index was .302. This index was raised to .343 after introducing the algorithm as an evaluator. After offering the responses proposed by the algorithm, Cohen's κ was improved in 9 of the 10 evaluators, and Fleiss’ κ rose to .711.ConclusionsThe agreement between otorhinolaryngologists in choosing prophylaxis for MV can be defined as “fair”. The responses of the algorithm for the choice of prophylaxis were close to the average opinion of the otolaryngologists, raising the agreement between them to “substantial”.     

Resultados de cirugía endoscópica nasal en el tratamiento de sinusitis fúngica invasiva en niños con cáncer e inmunosupresión

Background and objectiveto describe the results of the treatment of invasive fungal sinusitis with nasal endoscopic surgery in an immunocompromised paediatric oncological population.Methodsretrospective study of all patients diagnosed with invasive fungal sinusitis operated in the National Paediatric Oncology Unit between 2012 and 2016. Data taken from their medical history included: epidemiological characteristics, oncological diagnosis, haematological data, symptoms, tomographic studies, surgical interventions, results of pathology and cultures, medications received, complications, evolution and survival.Results18 patients were identified, 7 male and 11 female. The average age was 12 years, 13 had a diagnosis of acute lymphocytic leukemia and 5 of acute myeloid leukemia. Seventeen patients presented severe neutropenia at the time of diagnosis. The most frequently identified aetiological agent was Aspergillus in 13 patients. In 16 patients (89%) the disease was controlled with nasal endoscopic surgery. Ten patients died due to unrelated causes throughout the study.Discussion and conclusionsInvasive fungal sinusitis should be considered a medical emergency due to its high mortality. The diagnosis is based on a high index of suspicion in patients with predisposing factors (leukaemia, neutropenia, persistent fever, nasogastric tube) and endoscopic nasal evaluation. Antifungal medical treatment and aggressive nasal endoscopic surgery is indicated regardless of the patient's condition to reduce the fungal burden and associated high mortality. The treatment must be provided by a multidisciplinary team that includes paediatrics, haemato-oncology, infectology and otorhinolaryngology.     

Análisis de los servicios de otorrinolaringología acreditados para la formación de residentes

The aim of this study was to obtain information on the current educational offer of the authorized Units with the intention of evaluating their teaching capacity and identify their weaknesses and shortcomings. For this purpose an electronic, self-completing questionnaire was sent to the various teaching units. In addition, information on the most important aspects of the management of hospitals was also collected. Fifty-eight forms were received and except for 5 cases the information from the management of the hospitals was also received. The resources for external consultation, the number of special examinations in Audiology, Speech and Otoneurology, the resources in the operating room and the number of surgical interventions as well as the scientific activity developed in the last 5 years, was outlined. From the figures obtained, some critical areas were identified for the training of current residents in otolaryngology, which were also scored. Considering a threshold of 5 points, excluding the performance of several of these basic requirements, 19 services were below the threshold.     

Significado pronóstico de los niveles de albúmina previos al tratamiento en los pacientes con carcinoma escamoso de cabeza y cuello

Introduction and objectivesPre-treatment albumin levels have been shown to have prognostic capacity in oncological patients. The aim of this study is to analyse the relationship between albumin levels and prognosis in patients with head and neck squamous cell carcinoma (HNSCC).MethodsWe performed a retrospective study in a cohort of 741 patients with HNSCC and a plasmatic albumin testing within the 4 weeks prior to the start of treatment. The relationship between disease-specific survival and plasma albumin levels was analysed by a recursive partitioning analysis.ResultsAlbumin levels showed a directly proportional and statistically significant association with disease-specific survival. According to the results of the recursive partitioning analysis, the cut-off points with a higher prognostic capacity were 37.5 g/L and 46.1 g/L. Taking patients with albumin levels > 46.1 g/L as the benchmark, patients with albumin levels between 37.5-46.1 g/L had a 1.44 times higher risk of disease-specific death (95% CI: .95-2.19, P = .081), and patients with levels < 37.5 g/L had a 3.19 times higher risk (95% CI: 2.01-5.04, P = .0001). The differences in survival based on albumin levels were only seen in patients with advanced stage tumours (stages III-IV).ConclusionPre-treatment plasmatic albumin is an independent prognostic factor for patients with advanced stage HNSCC (III-IV), 37.5 g/L being the cut-off point with the highest prognostic capacity.     

Aticoexposición-antroexclusión como técnica quirúrgica a la demanda para el tratamiento del colesteatoma

Introduction and objectiveAttic exposure and antrum exclusion (AE-AE) is an on demand surgical technique for the treatment of cholesteatoma. Several techniques have been described with variable recurrence rates. The aim of the study was to describe this surgical technique and its indications and to analyse long-term outcomes.Materials and methodsForty-two patients were included. They received AE-AE in a tertiary centre and were followed-up from 6 months to 7 years. The surgical technique exposes the attic by drilling the superior wall of the external auditory canal and excludes the antrum and the mastoid cells by closing the aditus with a cartilage graft. It is indicated if the lesion does not go beyond the aditus or, if it does, it is a delimited cholesteatoma not damaging the labyrinth. The patients were followed-up by physical examination and radiology (CT scan and Non-EPI diffusion-weighted MRI since 2009).ResultsThe recurrence rate of the cholesteatoma was 4.8%. At recurrence, an open canal-wall-down mastoidectomy technique was performed.The rate of otorrhea (2/42 cases), serous otitis (2/42) and other complications was low, so aquatic activities were not contraindicated. The AE-AE did not modify ossicular chain reconstruction with respect to the rest of surgical techniques.ConclusionsAE-AE is a canal-wall-down technique. Its purpose is to remove the lesion and to reduce the recurrence of cholesteatoma. In addition, it allows the entrance of water and reduces the need for 2^nd look surgery.Non-EPI diffusion-weighted MRI is a reliable technique for follow-up, especially for the excluded mastoid.     

Actualización en el tratamiento del schwannoma vestibular

The increase in the diagnosis of ever smaller vestibular schwannomas (VS), the fact that many tumours can be observed with serial MRI, and the development of radiosurgery as an alternative to microsurgery have led the neurotologic surgeon to a new global approach to patients with VS. On the other hand, the spread of internet-based information sources, often with biased or incomplete information, makes counselling patients with VS a challenging task. This study provides an overview of the natural history of these tumours and the main therapeutic options: observation, surgery and radiosurgery, with comments on their indications, advantages and disadvantages. Due to the completely different approach and peculiar features of bilateral VS in patients with type II neurofibromatosis, these are excluded.     

Latencia de los microfónicos cocleares

Introduction and objectiveBy using appropriate instrumentation, we have found that cochlear microphonics (CM) advance or delay their appearance, depending on the sound pressure that generates them. This time variation is on the order of microseconds. We have not found any reference to this behaviour, which is why we make the finding known.Material and methodWe used the standard instrumentation specified for the study of CM. The method was based on the phase shift function of the CM according to the intensity of the stimulus.ResultsLatency was observed in CM, and we determined that latency time diminishes as the intensity of the stimulus increases.ConclusionsFrom the sound stimulus to the bioelectric potential transduction, there is a time period of microseconds, the shorter the more powerful the stimulus. This suggests that electromechanical transduction is not a simple mechanical process.