Evaluación de la disfunción de la trompa de Eustaquio mediante el cuestionario de disfunción tubárica (ETDQ-7) y la tubomanometría

ObjectiveEvaluation of the severity of Eustachian tube dysfunction using the Spanish validation of the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) and tubomanometry (TMM).Materials and methodsSpanish validation of the ETDQ-7. Patients: Prospective study with 125 patients, 75 of whom reported symptoms compatible with Eustachian tube dysfunction. Outcome measures: The Spanish version of the ETDQ-7 was administered after translation and back-translation. Internal consistency and reliability were established. Usefulness evaluation of TMM plus ETDQ-7 in the study of Eustachian tube dysfunction.ResultsThe Spanish adaptation of the ETDQ-7 showed high reliability and internal consistency. TMM and ETDQ-7 together showed increased sensitivity and specificity in the diagnosis of Eustachian tube dysfunction.ConclusionsThe Spanish adaptation of the ETDQ-7 is valid, reliable and can be used in a clinical setting to quantify the impact and severity of chronic dysfunction on patients’ lives. A new test formed by combining ETDQ-7 and TMM could be a routine test in the diagnosis of Eustachian tube dysfunction.     

Metástasis fronto-etmoidal de adenocarcinoma prostático. presentación de un caso clínico y revisión de la literatura

Prostatic metastases in the nose and paranasal sinuses are rare. Less than 100 cases have been reported in the literature. Kidney are the commomest site of primary tumour, followed by lung and breast. Only 10 cases have previously been reported in the world literature. Prostatic metastases have been mainly reported in the sphenoid sinus. This paper reports one case of metastases of prostatic carcinoma in the fronto-ethmoid sinus in a 72 years old male. The clinical picture includes acute frontoethmoid right sinusitis, severe exophthalmos and chemosis. The CT scan showed extensive soft tissue filling the maxillary, ethmoid cells, shpenoid and frontal right sinuses, with subdural abscess. Biopsies from the frontoethmoid mass showed infiltration by adenocarcinoma with positive immunostaining for prostatic specific antigen. We also review the literature about metastases involving the nose and paranasal sinuses.     

Tumores glóticos precoces con afectación de la comisura anterior. Revisión bibliográfica y documento de consenso. Comisión de cabeza y cuello y base de cráneo. SEORL-CCC

The choice of the most appropriate treatment in early-stage glottic cancer with anterior commissure involvement remains controversial. Its therapeutic management is complex because it is a significant prognostic indicator of local control with 37% recurrence, due to the difficulty in establishing tumour extension with understaging of up to 40%, and due to the comparison of results in series on tumours that behave variably as they progress, such as T1a, T1b and T2a with commissure involvement. Furthermore, the complexity of the surgical approach using transoral CO2 laser microsurgery requires surgical skill, appropriate equipment and experience. Aspects to be reviewed in this document are: an updated anatomical definition of the anterior commissure, tumour progression based on histopathological studies, usefulness of videostroboscopy and NBI in diagnostic accuracy, validity of imaging tests, oncological results published in series reviews, systematic reviews and meta-analyses, tumour margin treatment and voice evaluation.Finally, by way of a summary, the document includes a series of recommendations for the treatment of these tumours.     

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.     

Cáncer de hipofaringe: análisis de la evolución y los resultados del tratamiento en nuestro medio

ObjectiveHypopharyngeal carcinoma is an aggressive malignancy usually diagnosed at a late state, thereby resulting in overall poor prognosis and low survival rates for these patients. The purpose of this study is to present the progress and outcomes of patients treated for hypopharyngeal carcinoma at our department.Material and methodWe retrospectively reviewed 89 patients who had been diagnosed with hypopharygeal carcinoma between 1980 and 2005. Most of the tumours were advanced (T3 and T4) and 73 % showed palpable regional metastases at presentation.ResultsThe five-year survival rate was 40.7 %. The overall incidence of distant metastases and subsequent primary neoplasms was 7.5 % and 23.5 %, respectively.ConclusionsHypopharyngeal cancer is still the one with the worst prognosis in the head and neck area. The poor survival rate seems to be related primarily to advanced stage disease at presentation and particularly to the status of cervical lymph-node metastases.     

Neurofibromatosis tipo ii y sus manifestaciones en cabeza y cuello: revisión bibliográfica y estudio poblacional en la Comunidad de Cantabria y la provincia de Las Palmas

Introduction and objectivesNeurofibromatosis type 2 (NF2) is an infrequent autosomal dominant disease characterised by the appearance of viii nerve schwannomas, meningiomas and ocular abnormalities. Incidence of 1:25,000 and prevalence above 1:80,000 are estimated in general. The objectives of our study were to determine current prevalence of NF2 in the Community of Cantabria and the province of Las Palmas, and its head and neck manifestations.Material and methodsThis was a population-based, retrospective study in 3 tertiary hospitals.ResultsThe study population showed prevalence of 1:600,000 in the Community of Cantabria and 1:280,000 in the province of Las Palmas. The most frequently diagnosed tumour was acoustic neuroma (n = 15), followed by trigeminal neurinoma (n = 2) and vagus (n = 1).ConclusionsCases of NF2 are infrequent in Cantabria and Las Palmas, lower than that reported in the literature. The most frequently described head and neck tumour in the literature is acoustic neuroma, followed by schwannoma of cranial nerves v and x. Other tumours such as nasal, laryngeal, chorda tympani or cranial nerve vii schwannomas are also described. The most frequent ENT manifestation is hearing loss, especially unilateral, followed by cervical mass, tinnitus and headache. Early diagnosis and multidisciplinary management in specialised centres could improve life expectancy and quality of life for these patients.     

Plasmocitoma solitario de cabeza y cuello. Presentación de tres casos y revisión de la literatura

Solitary plasmocytoma is a rare plasmactic cell tumor occurring in the head and neck. These constitute, less than 1% of all head and neck malignancies. On initial presentation they must be differentiated from multiple myeloma. This may prove to be difficult because a varying percentage may be associated at a later date with the development of multiple myeloma. We describe three cases of plasmocytomas, one ocuured in the larynx, in the cavity nasal and other in the skull base. The clinical characteristices, diagnosis criteria and therapeutic problems (radiation, surgery or a combination of booth) are discussed and reviewed in the literature.     

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”.     

Análisis de la supervivencia específica y el control local mediante un análisis de partición recursiva en pacientes con carcinomas de cabeza y cuello

Introduction and objectivesRecursive partitioning analysis (RPA) is a technique that allows prognostic classification in oncological patients. The aim of the present study is to analyse by means of an RPA a cohort of patients with squamous carcinomas of the head and neck (SCHN).Methods5,226 SCHN were retrospectively analysed with an RPA, considering the specific survival and local control of the disease as dependent variables. A cohort of patients was used for the creation of the classification model, and another cohort was used to carry out its internal validation.ResultsConsidering specific survival as a dependent variable we obtained a classification tree with 14 terminal nodes that were grouped into 5 categories, including as partition variables the local and regional extent of the tumour, and the location of the tumour. When considering the local control of the disease as a dependent variable we obtained a classification tree with 10 terminal nodes that were grouped into 4 categories, including as partition variables the local extension and location of the tumour, the type of treatment performed, the age of the patient, and if it was a first tumour or a subsequent neoplasm. The validation study confirmed the prognostic capacity of the models developed with the RPA. One of the advantages of the RPA is that it allows the identification of groups of patients with specific behaviour.ConclusionRPA is shown to be an effective technique for the prognostic classification of patients with a SCHN.     

Incidencia,estancia hospitalaria y factores de riesgo asociados a la aparición de fístula faringocutánea poslaringectomía

Introduction and objectivesPharyngo-cutaneous fistula (PCF) is one of the main problems for patients undergoing total laryngectomy. There are many risk factors described and associated with the appearance of PCF; however, some of these are currently under discussion.The aim of this work is to analyse the incidence of PCF, hospital stay and associated risk factors in patients undergoing total laryngectomy in a secondary hospital.MethodsThis was an observational study in a retrospective cohort. We included all patients who underwent total laryngectomy between 2006 and 2011. We considered sociodemographic and clinical items, and most of the risk factors studied in the literature by other authors (tracheostomy, tumour stage, chemotherapy or radiotherapy before surgery, etc.). Statistical analyses were performed using SPSS^® 15.0 and Epidat^® 3.1.ResultsWe analysed 70 total laryngectomies. The incidence of PCF in the time period studied was 48.6%. There were significant differences between the mean hospital stay of patients with and without PCF. Affected locoregional lymph nodes were found to be the only risk factor for the occurrence of PCF [RR=1.60 (1.006-2.54)].ConclusionThe incidence of PCF is associated with the presence of affected locoregional lymph nodes. It is not associated with tracheostomy, administration of radio/chemotherapy before surgery or tumour location.     

Ototoxicidad en la edad pediátrica: recomendaciones de la CODEPEH (Comisión para la Detección Precoz de la Hipoacusia infantil) para su prevención y diagnóstico precoz

Ototoxicity is defined as the damage, reversible or irreversible, produced in the inner ear by various substances that are called ototoxic and that can cause hearing loss and/or an alteration of the vestibular system.Permanent hearing loss significantly affects quality of life and is especially important in children. The lack or delay in its detection is frequent, since it often progresses in an inconspicuous manner until it affects communication and overall development. This impact can be minimized by following a strategy of audiological monitoring of ototoxicity, which allows for its early detection and treatment. This document recommends that children who are going to be treated with cisplatin or aminoglycosides be monitored.This CODEPEH review and recommendation document focuses on the early detection, prophylaxis, otoprotection, monitoring and treatment of ototoxicity caused by aminoglycosides and platinum-based antineoplastics in the paediatric population.     

Importancia de la cuantificación del desplazamiento hioideo en la valoración del estadio y evolución de la disfagia orofaríngea

Introduction and objectivesThe objective of this paper was to show our experience and considerations when quantifying hyoid bone displacement and to observe its correlation with the qualitative scales that evaluate dysphagia.MethodsHyoid displacement was assessed using the method described by Molfenter and Steele's group in 2014 in a series of 14 patients affected by oropharyngeal dysphagia. The degree of dysphagia was also qualitatively assessed with the Rosenbek Penetration and Aspiration Scale (PAS) of 1996 and with the Functional Oral Intake Scale (FOIS) of Crary of 2005. All assessments were done before and after treatment.ResultsAll patients increased their hyoid bone total displacement after the treatment. These variations were highly correlated with the variations in the PAS scale with aspiration or penetration. However, the variations of hyoid bone displacement did not correlate with the FOIS scale.ConclusionsThe improvement in total hyoid bone displacement is a clinical indicator of improved aspiration of patients suffering dysphagia. However, the improvement of this displacement is not related to the oral intake tolerance of the patients.     

Análisis de la potencia de salida y del rendimiento auditivo de los dispositivos auditivos osteointegrados

Background and objectiveOsseointegrated auditory devices are hearing gadgets that use the bone conduction of sound to produce hearing improvement. The mechanisms and factors that contribute to this sound transmission have been widely studied, however, there are other aspects that remain unknown, for instance, the influence of the processor power output. The aim of this study was to know if there is any relationship between the power output created by the devices and the hearing improvement that they achieve.Materials and methodsForty-four patients were implanted with a percutaneous Baha® 5 model. Hearing thresholds in pure tone audiometry, free-field audiometry, and speech recognition (in quiet and in noise) were measured pre and postoperatively in each patient .The direct bone conduction thresholds and the power output values from the processors were also obtained.ResultsThe pure tone average threshold in free field was 39.29 dB (SD 9.15), so that the mean gain was 29.18 dB (SD 10.13) with the device. This involved an air-bone gap closure in 63.64% of patients. The pure tone average threshold in direct bone conduction was 27.6 dB (SD 10.91), which was 8.4 dB better than the pure tone average threshold via bone conduction. The mean gain in speech recognition was 39.15% (SD 23.98) at 40 dB and 36.66% (SD 26.76) at 60 dB. The mean gain in the signal-to-noise ratio was ?5.9 dB (SD 4.32). On the other hand, the mean power output values were 27.95 dB μN (SD 6.51) in G40 and 26.22 dB μN (SD 6.49) in G60. When analysing the relationship between bone conduction thresholds and G40 and G60 values, a correlation from the frequency of 1,000 Hz was observed. However, no statistically significant association between power output, functional gain or speech recognition gain was found.ConclusionsThe osseointegrated auditory devices generate hearing improvement in tonal thresholds and speech recognition, even in noise. Most patients closed the air-bone gap with the device. There is a direct relationship between the bone conduction threshold and the power output values from the processor, but only in mid and high frequencies. However, the relationship between power output and gain in speech recognition is weaker. Further investigation of contributing factors is necessary.     

Análisis y tratamiento de la dismorfia nasal secundaria a fisura labiopalatina

Introduction and objectivesCleft lip and palate are usually associated with craniofacial defects and nose deformities that alter the facial aesthetic configuration. After initial surgical treatment, further surgery (both nasal and maxillary) is often required to reduce the physical impact in these patients. These techniques should be delayed until the development of the facial skeleton is complete. The purpose of this study was to assess the system used in the preoperative analysis of such patients, the surgical technique and our results after proper follow-up time.Material and methodsThis was a retrospective study describing the medical history of patients with background of unilateral cleft lip treatment in childhood who underwent surgery in our service to correct their nasal deformity between June 2010 and June 2011.ResultsWe evaluated 5 cases on which we performed a functional, aesthetic, anthropometric and psychological analysis. The treatment was carried out at an average age of 18.3 years, with an individualised surgical technique using open septorhinoplasty. The mean follow-up time was 24.5 months.ConclusionsPreoperative analysis for this condition should include an aesthetic and functional nasal study and an anthropometric and psychological study. Open septorhinoplasty carried out at the age of 16-18 years is an appropriate procedure to correct the cleft lip nasal and palate deformity. Our surgical technique offers good long term functional, aesthetic, anthropometric and psychological outcomes.