Experiencia de 10 años en pacientes operados por rinosinusitis fúngica invasiva aguda

IntroductionAcute invasive fungal rhinosinusitis (AIFRS) is rare but has high mortality. It is more frequent in immunocompromised patients with multiple comorbidities, which make their management more difficult. The aim of this study is to describe a cohort of patients operated due to AIFRS, their clinical characteristics, mortality, aetiological agent and efficacy of diagnostic tests.Material and methodNon-concurrent prospective study of patients with AIFRS who were operated between 2005 and 2015 in our centre.ResultsThirty-two patients were included, 62.5% (20/32) men, with an average age of 39.4 years (16-65 years). Overall mortality was 71.9%; acute mortality 46.9% and late mortality 25%. Haematological malignancies were the most common underlying disease, present in 84.4% (27/32) of cases, followed by diabetes mellitus in 9.4% (3/32). On diagnosis, 62.5% (20/32) of patients were neutropenic, 80% (16/20) of them with febrile neutropenia. Fever was the most frequent symptom, present in 65.6% (21/32) of patients, followed by facial pain or headache in 53.1% (17/32). Aspergillus was identified in 37.5% (12/32) of cases and Rhizopus in 31.3% (10/32). There was no association between the analysed variables and increased risk of mortality.ConclusionsAIFRS is an aggressive disease with a high mortality rate, therefore a timely diagnosis is fundamental. It is necessary to optimise suspicion criteria for an early diagnosis in order to improve the prognosis.     

Exploración videoendoscópica bajo sueño inducido en niños

This document is intended as a guide for Spanish ENT specialists who want to perform drug-induced sleep endoscopy. Indications, sedation method and important findings are discussed to unify criteria and methodology.     

Utilidad de los colgajos e injertos endonasales en cirugía endoscópica nasosinusal y de base de cráneo. Documento de consenso

IntroductionSkull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes.ObjectivesThe target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery.Material and methodsLiterature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects.ResultsWe obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts.ConclusionsWe present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.     

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.     

Influencia de la premedicación con esteroides sistémicos en el sangrado y visualización del campo quirúrgico durante la cirugía endoscópica nasosinusal

IntroductionChronic rhinosinusitis (CRS) is the inflammation of the nasal and paranasal sinus mucosa persisting for at least 12 weeks. The success of endoscopic sinus surgery (ESS) depends on minimising oedema and intraoperative bleeding. For this purpose, some surgeons advocate the use of preoperative systemic steroids (SS).Our aim was to assess if the administration of preoperative SS in patients with CRS with or without nasal polyps (NP) facilitates the surgical procedure.MethodsNon-randomized clinical trial in CRS patients with or without NP. Patients in the ESS group received oral meprednisone preoperatively, whereas the control group did not. The visibility of the surgical field, intraoperative bleeding and surgery duration were recorded.ResultsEach group (SS group and control group) included 27 patients. The administration of SS reduced the values of all the parameters in patients without NP, with no significant differences. In patients with NP, only operative bleeding was reduced significantly.ConclusionsEven though all the parameters decreased with the preoperative administration of SS, only operative bleeding was significantly reduced in patients with CRS with NP.     

Screening auditivo en niños con factores de riesgo de hipoacusia en el área 3 de madrid

The early identification of the hearing loss is very important to begin a early rehabilitation and to get a normal development of the language. Because of reason, the newborn hearing screening started, mainly in cases with risk factors. The objective of this report is to study the incidence of hearing loss in children with risk factors in the area 3 of Madrid. We realyzed hearing screening in 138 children in a period of 3.5 years, by otoacoustic emissions in younger 1 year and auditory brain stem evoked response in older 1 year. The results show that the incidence of sensorineural hearing loss is 4.34% of cases in children with risk factors, and more specifically 2.8% of bilateral profound hearing loss, and too, we detected 6.5% of transmisive hearing loss. The age of identification of hearing loss decreased to 6 months with the hearing screening programms. These results support the need of realization of hearing scrrening programms with obligatory character, though we advocate for the universal screening to include all cases of hearing loss without risk factors     

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.     

Adaptación transcultural en versión de lengua española del cuestionario Dizziness Handicap Inventory en la población pediátrica. Análisis de su aplicación en niños

BackgroundThe Dizziness Handicap Inventory (DHI) is a questionnaire to assess self-perception of disability produced by the effects of vestibular system disorders.It is a tool used by professionals who treat patients with balance disorders, although it is not widely used in children.The aim of this study is to carry out a cross-cultural and linguistic adaptation of the DHI children/adolescent in the Argentine population from a version already published in Portuguese and to evaluate it in a group of patients.Materials and methodsA cross-cultural adaptation was carried out, maintaining semantic, conceptual, content, technical and criteria equivalence; and it was verified that the new Argentinian version of the DHI for children and adolescents maintains the reliability of the original questionnaire. According to Beaton's et al. recommendations, the questionnaire was translated from Portuguese to Spanish (Argentine) by 2 different translators and a back-translation to the original language by 2 other translators. Since this questionnaire is directed at a paediatric population, some terms were adapted to be understood by children from 4 years old. A psychopedagogue and a psychologist joined the team to delve more deeply into the questions that focus on the emotional or psychological aspects of the symptom.ResultsNo difficulties were found in obtaining equivalent expressions from the original questionnaire to Spanish (Argentine). The internal consistency of this cross-culturally adapted questionnaire was like those already published in other languages. Most paediatric patients do not have disabilities in the areas studied. The patients with the highest total scores presented vestibular migraine as a diagnosis.ConclusionsThis questionnaire will be culturally and linguistically adapted for use in the Argentine population. The emphasis was placed on terms and expressions that could be understood by the paediatric population.     

Comparación de la producción vocal en niños con hipoacusia prelocutiva con adaptación audioprotésica e implante coclear con normooyentes

Introduction and objectivesInadequate auditory feedback in prelingually deaf children alters the articulation of consonants and vowels.The purpose of this investigation was to compare vowel production in Spanish-speaking deaf children with cochlear implantation, and with hearing-aids with normal-hearing children by means of acoustic analysis of formant frequencies and vowel space.MethodsA total of 56 prelingually deaf children (25 with cochlear implants and 31 wearing hearing-aids) and 47 normal-hearing children participated. The first 2 formants (F1 and F2) of the five Spanish vowels were measured using Praat software. One-way analysis of variance (ANOVA) and post hoc Scheffé test were applied to analyze the differences between the 3 groups. The surface area of the vowel space was also calculated.ResultsThe mean value of F1 in all vowels was not significantly different between the 3 groups. For vowels /i/, /o/ and /u/, the mean value of F2 was significantly different between the 2 groups of deaf children and their normal-hearing peers.ConclusionBoth prelingually hearing-impaired groups tended toward subtle deviations in the articulation of vowels that could be analyzed using an objective acoustic analysis programme.     

Consenso sobre el tratamiento de la disfunción tubárica obstructiva mediante dilatación con balón

ObjectiveThere is a great variability in diagnosis of obstructive Eustachian tube dysfunction and its treatment by balloon Eustachian tuboplasty (BET). The aim of this paper was to present a consensus on indications, contraindications, methodology, complications and results after BET.Material and methodsWe obtained a consensus on BET, after a systematic review of the literature on BET from 1966 to November 2018, using MESH terms «Eustachian tube and (dilation or dysfunction)», including a total of 1.943 papers in Spanish, English, German and French. We selected 139 papers with a relevant abstract, including two international consensuses, seven systematic revisions, and two randomised control trials on BET.ResultsThe indications for BET are barotrauma, serous otitis media, adhesive otitis, atelectatic middle ear and failure after tympanoplasty, once obstructive Eustachian tube dysfunction is confirmed. BET is more effective in barotrauma and serous otitis media. There are high- evidence reports on BET showing good results that persist long-term, as compared to conservative medical treatment.ConclusionsBET is a surgical, minimally invasive treatment that has shown its effectiveness and safety in obstructive Eustachian tube dysfunction in adults and children. It is most effective in barotrauma and serous otitis media.     

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.     

¿Es necesario repetir el estudio de sueño de control a todos los niños con SAHOS moderado-severo tras la cirugía?

Hypertrophy of adenotonsillar tissue is the most common cause of OSAS in otherwise healthy children, and therefore adenotonsillectomy is the first line treatment. Scientific societies recommend nocturnal follow-up PSG to assess for residual OSAS in children with preoperative evidence for moderate to severe OSAS, obesity, craniofacial anomalies that obstruct the upper airway and neurological disorders, based on the increasing trend of publications reporting residual OSAS after adenotonsillectomy. Follow-up PSG values in children with a pre-operative diagnosis of severe OSAS were analysed retrospectively, and compared to the parents’ impression after ENT surgery. The study population included 41 healthy children with severe OSAS and adenotonsillar surgery. The percentage of children with normal PSG parameters (AHI < 2/h) after adenotonsillectomy was 80.48%. A very good correlation was observed between the parents’ perception after treatment and the follow-up PSG parameters, specifically when the parents perceived that the patient had shown «complete resolution» (no snoring or apnoea), 90.62% of the children had an AHI < 2/h in the follow-up PSG, the maximum residual AHI being 2.6/h. In healthy children with no underlying pathology, the information provided by the parents on clinical progression after surgery could be useful and might enable the selection of those patients who require a follow-up study, avoiding overload in sleep units.     

Recomendaciones sobre el uso de la neuromonitorización en cirugía de tiroides y paratiroides

Introduction

Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary.

Exploración videoendoscópica con sueño inducido,utilidad clínica y revisión de la literatura

Fiberoptic examination of the pharynx under drug-induced sleep is a test that helps to detect the areas of vibration and collapse in patients with sleep-disordered breathing. This article is a review of the available literature on the subject, aimed at helping otolaryngologists to understand the procedure and to resolve some controversies surrounding it.     

Factores implicados en el éxito y fracaso de la dacriocistorrinostomía endoscópica desde nuestra experiencia

IntroductionChronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure.Patients and methodsA retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months.ResultsOver 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7±11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest.ConclusionsEDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.