Resultados tras la rehabilitación vestibular y terapia Wii® en pacientes con hipofunción vestibular unilateral crónica

Introduction and objectivesVestibular rehabilitation therapy is an exercise-based programme designed to promote central nervous system compensation for inner ear deficit. The objective of the present study was to analyse the differences in the perception of handicap, the risk of falls, and gaze stability in patients diagnosed with chronic unilateral vestibular hypofunction before and after vestibular rehabilitation treatment with complementary Wii^® therapy.Materials and methodsA review was performed on the clinical histories of patients in the vestibular rehabilitation area of a university hospital between April 2009 and May 2011. The variables studied were the Dizziness Handicap Inventory, the Dynamic Gait Index and dynamic visual acuity. All subjects received complementary Wii^® therapy.ResultsThere were 69 cases (41 woman and 28 men), with a median age of 64 years. The initial median Dizziness Handicap Inventory score was 40 points (range 0-84, percentile 25-75 = 20-59) and the final, 24 points (range 0-76, percentile 25-75 = 10.40), P < .0001. The initial median for the Dynamic Gait Index score was 21 points (range 8-24, percentile 25-75 = 17.5-2.3) and the final, 23 (range 12-24, percentile 25-75 = 21-23), P < .0001. The initial median for dynamic visual acuity was 2 (range 0-6, percentile 25-75 = 1-4) and the final, 1 (range 0-3, percentile 25-75 = 0-2), P < .0001.ConclusionA reduction was observed in the Dizziness Handicap Inventory Values. Values for the Dynamic Gait Index increased and dynamic visual acuity improved. All these variations were statistically significant.     

Precisión diagnóstica de la citología por punción aspiración con aguja fina en tumores de la glándula parótida

Introduction and objectivesFine needle aspiration cytology (FNAC) is a globally accepted technique in the preoperative evaluations of head and neck tumours; however, the effectiveness in the interpretation of salivary glands neoplastic lesions is still controversial. The objective of this study consisted of assessing the efficacy of FNAC in preoperative diagnosis of parotid tumours.MethodsThis retrospective study was conducted using 93 patient samples with parotid gland tumoral pathology, treated at the Otorhinolaryngology Department in our institution during the 2007-2011 period. Preoperative FNAC was employed and the patients subsequently submitted to surgical excision with histopathological diagnosis of the specimen. Cytology results were classified as negative for malignancy, positive for malignancy or insufficient sample, and later compared with the definitive histological diagnosis.ResultsThe mean age of the studied sample was 52.9 years (range: 11 to 88 years); 55.9% were men. The FNAC showed significant sensitivity of 57.1%, with a specificity of 95.1%, for detecting malignancy in parotid gland tumours. The positive and negative predictive values for malignancy were 50 and 96.3%, respectively.ConclusionsFNAC is considered a simple test but of limited use for diagnostic guidance in tumour pathology of the parotid gland in our environment, mainly because of its low sensitivity. However, the high specificity and high negative predictive value of FNAC makes it a more accurate test in benign or negative result cases.     

Evaluación de la incapacidad en pacientes con acúfenos

ObjectivesTinnitus handicap evaluation through Spanish validation of the Tinnitus Handicap Inventory. Study Design: Spanish validation of the Tinnitus Handicap Inventory.PatientsEighty patients referred to our Tinnitus Unit in University Hospital, between September and December, (1999). Outcome Measures: The Spanish version of the Thi was administered after translation and retrotranslation. Internal consistency and reliability were established.ResultsSpanish adaptation of the THI and its subscales (functional, emotional and catastrophic) showed a high reliability and internal consistency (Cronbach’s alfa: 0.90).ConclusionsSpanish adaptation of the THI is valid, reliable and can be used in a clinical setting to quantify the impact of tinnitus on patient’s quality of life.     

Profilaxis antibiótica en amigdalectomías y su relación con la morbilidad postoperatoria

Introduction and objectivesPostoperative pain is the main symptom and the most incapacitating one in tonsillectomy, and prescribing oral antibiotics to reduce postoperative pain is common. The objective of this study was to evaluate the efficacy of 2 different prophylactic antibiotic schemes to reduce postoperative morbidity in paediatric patients undergoing tonsillectomy. One scheme consisted of a single-dose preoperative cephalothin, while the second was an oral antibiotic.MethodsThis was an open randomized trial on patients aged 4-15 years undergoing tonsillectomy. The experimental group received single-dose intravenous cephalothin, while the control group received single-dose intravenous cephalothin plus oral suspension of amoxicillin/clavulanate for 7 days. We compared the presence and intensity of pain, limitations to normal diet, habitual activities, halitosis, otalgia and nausea within 7 days after surgery using the Wong-Baker FACES Pain Scale and a questionnaire for the parents.ResultsFor the 102 patients that underwent tonsillectomy (51 per group), there was no difference in the presence and severity of postoperative pain between the 2 groups (P>.05). Neither was there any difference in the days needed to return to normal activities, normal diet, and duration of days with halitosis, otalgia or nausea. Just 1 patient from the control group had postoperative bleeding. There were no infectious complications.ConclusionsThe use of single-dose preoperative intravenous cephalothin has the same efficacy as the use of oral amoxicillin/clavulanate for 7 days in reducing morbidity in paediatric patients undergoing tonsillectomy and offers safe antimicrobial prophylaxis. Consequently, the routine use of oral antibiotics should be avoided.     

BAHA: nueva incisión longitudinal con implante fuera de ésta

Since the introduction of bone-anchored hearing aids (BAHA) a few decades ago, their effectiveness has made the use of these devices a well-established method. The most common complications associated with BAHA are dermatological, so a lot of changes were introduced in the surgical technique to reduce the frequency of skin reactions. We have analyzed our experience in the management of the skin and soft tissues over 8 years’ experience with BAHA. We present a new longitudinal incision with the fixture out of the incision.     

Calidad de vida de pacientes implantados con el dispositivo BAHA según su indicación

Introduction and objectivesAssess the improvement of quality of life in osseointegrated implanted patients, taking into account the indication as well as the use of the implant, and the presence of pre- and postoperative tinnitus.MethodsSixty-nine patients implanted between June 2004 and November 2010 were included. The average age of the patients was 40 years. The instruments used to quantify the change in quality of life were the Glasgow Benefit Inventory and a questionnaire including open questions, bone anchored hearing aid (BAHA) use, change in tinnitus and postoperative pain.ResultsThe average total benefit score with the Glasgow Benefit Inventory was 38, and the general, social, and physical scores were 51, 15 and 7, respectively. There was no significant association between sex, age and bilaterality or unilaterality of the process with quality of life. Nevertheless, there were significantly better results in patients with conductive hearing loss than in those with unilateral deafness, the results were positive although in both groups. The tinnitus rate went from 37.5 to 20.8% following BAHA, with this difference being significant.ConclusionsOur results show that the use of BAHA is associated with a great improvement in quality of life for patients with conductive hearing loss, whereas indications in unilateral deafness have to be individually studied. Moreover, the study shows that BAHA has a positive effect upon tinnitus.     

Variación del parámetro acústico harmonic-to-noise ratio en relación con distintos niveles de ruido de fondo

Introduction and objectivesAcoustic analysis is a tool widely used by professionals related to the study of voice that gives us information from a recording. It has been identified that in investigations carried out today that involve acoustic analysis, the recording process takes place in rooms with different levels of background noise. The objective of this study is to establish whether the acoustic parameter harmonic-to-noise ratio (HNR) varies in relation to the different background noise levels of the premises where the recording is made and recommend a maximum level of background noise.MethodsThrough the Praat programme, the average value of the acoustic parameter HNR of 43 subjects was obtained, inside the audiometric booth of the Universidad Autónoma de Chile, whose background noise level is 28.1 dB(A) and it was compared with the HNR average values obtained with higher background noise levels.ResultsThe HNR average values decreased from 19.8 to 14.0 dB(A) as the background noise level of the premises increased from 28.1 to 57.8 dB(A). The t-test for dependent samples was performed, with which the HNR average values obtained were compared with the baseline background noise level (28.1 dB[A]). Significant differences were found with the baseline background noise level when the room noise level was higher than 47.7 dB(A).ConclusionsThe background noise of the premises where the voice recording for the acoustic analysis is performed, influences the value of the acoustic parameter HNR, which decreases as the background noise of the premises increases. It is recommended that the background noise level should not exceed 43.8 dB(A).     

Resultados funcionales a largo plazo en reconstrucción osicular con cartílago

Optimal hearing is one goal of otologic surgery. This study examines the long-term functional success rate of cartilage as graft material for ossicular chain reconstruction in type III tympanoplasty. A retrospective review of seventy-nine patients having undergone type III tympanoplasty (53 with closed techniques and 26 with open techniques) was made. Lateral graft (“onlay”) techniques were used in almost all cases. All operations were performed by one of the authors, a well-established otologic surgeon. Seventy-four percent of the reconstructions were performed in an one-stage procedure. The mean period of follow-up was 54 months (range 1-17 years). The results of air-bone gap closure and complications of the surgery are presented. Our results show that a significant percentage of patients gain a long-term substantial improvement in their hearing with minimal risk. However, this hearing inprovement tends to decline eventually in a progressive manner. A post-operative air-bone closure equal or < 30 dB was achieved in 92.2% of the all cases (n=79) with a mean gain of 9.72 dB. Functional outcomes in closed techniques were slightly better than in open techniques. There were few complications. Perforation and retraction of the tympanic graft were the most common observed complications. In conclusion, cartilage is an available, costless, reliable and technically easy to use graft material for functional reconstructions of the ossicular chain. It is a well-tolerated element in middle ear space as well as by the tympanic membrane, it has a very low risk of extrusion and a good long-term functional viability. Therefore, update cartilage is an interesting option in functional restoration of the ossicular chain as graft placed on the stapes capitulum.     

Preservación de órgano tras un tratamiento con quimioterapia de inducción en pacientes con carcinomas localmente avanzados (T3-T4) de cavidad oral y orofaringe

Introduction and objectivesWith the goal of achieving functional preservation, one of the treatment strategies for patients with locally advanced squamous cell carcinomas of the head and neck is to initiate treatment with induction chemotherapy (CT) and decide the second therapeutic manoeuvre depending on the response. The objective of this study is to evaluate organ preservation capacity based on this therapeutic approach in patients with tumours of the oral cavity and oropharynx.MethodsA retrospective study of 246 patients with locally advanced carcinomas of the oral cavity or oropharynx (cT3-T4) initially treated with induction CT.ResultsAfter induction CT 28% of patients achieved a complete response of the primary location of the tumour, 43.1% a partial response greater than 50%, and 28.9% a reduction less than 50% or persistence. After the induction CT treatment 70 patients (28.5%) underwent surgical treatment, and 176 (71.5%) radiotherapy (RT) or chemoradiotherapy (CRT). Considering the patients treated non-surgically (n = 176), organ preservation for patients with a complete response (n = 66) was 65.2%, for those patients with a partial response greater than 50% (n = 75) it was 30.7%, and for patients with a partial response less than 50% or persistence (n = 35) it was 14.3%.ConclusionThe response to treatment with induction CT has prognostic value in patients with locally advanced carcinomas of the oral cavity and oropharynx. Patients who are candidates for conservative treatment with RT or CRT would be those who achieve a complete response after induction treatment.     

Horizontal localization and speech intelligibility with bilateral and unilateral hearing aid amplification: Localización horizontal y discriminación del lenguaje con adaptación unilateral y bilateral de auxiliares auditivos

Speech intelligibility and horizontal localization of 19 subjects with mild-to-moderate hearing loss were studied in order to evaluate the advantages and disadvantages of bilateral and unilateral hearing aid (HA) fittings. Eight loudspeakers were arranged in a circular array covering the horizontal plane around the subjects. Speech signals of a sentence test were delivered by one, randomly chosen, loudspeaker. At the same time, the other seven loudspeakers emitted noise with the same long-term average spectrum as the speech signals. The subjects were asked to repeat the speech signal and to point out the corresponding loudspeaker. Speech intelligibility was significantly improved by HAs, bilateral amplification being superior to unilateral. Horizontal localization could not be improved by HA amplification. However, bilateral HAs preserved the subjects' horizontal localization, whereas unilateral amplification decreased their horizontal localization abilities. Front-back confusions were common in the horizontal localization test. The results indicate that bilateral HA amplification has advantages compared with unilateral amplification.

Sumario

Se estudió la inteligibilidad y la localización sonora horizontal en 19 sujetos con hipoacusia de nivel superficial a medio, para evaluar las ventajas y desventajas de la adaptación bilateral y unilateral de auxiliares auditivos (HA). Se colocaron en circulo ocho bocinas que cubrian el piano horizontal de los sujetos. A través de una bocina seleccionada al azar, se trasmitieron señales lingüisticas contenidas en una prueba de frases. Simultáneamente las otras siete bocinas emitian ruido del mismo espectro de duración que la señal lingüistica. Se les pidió a los sujetos que repitieran la señal lingüistica escuchada y que señalaran la bocina que la emitía. La inteligibilidad del lenguaje fue mucho mejor con la adaptación binaural de auxiliares auditivos que con la unilateral. No hubo mejoria en la localización horizontal con la adaptación de auxiliares auditivos. Sin embargo, la adaptación binaural preservó la localización horizontal, mientras que la adaptación unilateral disminuyó esa habilidad. La confusión entre frente y detrás es común en la prueba de localización horizontal. El resultado indica que la adaptación bilateral de auxiliares tiene ventajas sobre la adaptación unilateral.     

Cirugía radioguiada en el hiperparatiroidismo primario: resultados y correlación con el diagnóstico anatomopatológico intraoperatorio

Introduction and objectives

Radioguided surgery is a minimally invasive surgical technique for the treatment of primary hyperparathyroidism. The goals of our study were to evaluate the rate of success and compare the results with intraoperative histological analysis.

Precisión de la PAAF (punción aspiración con aguja fina) y la TAC (tomografía axial computerizada) en la diferenciación de tumores benignos y malignos de parótida en una serie de casos

Introduction

Parotid tumours, in addition to the wide variety of types, are histologically complex. Differentiating between benign and malignant tumours in preoperative diagnosis is important in deciding the type of surgery required. Fine needle aspiration cytology (FNAC) is a simple, quick, low-cost, low-invasive and well-tolerated tool used in the preoperative diagnosis of these tumours.

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.     

Significado pronóstico de la extensión extranodal en pacientes con carcinomas escamosos de cabeza y cuello cN0 con metástasis ganglionares ocultas

Introduction and objectives

Extranodal extension in nodal metastases is an independent adverse prognostic factor in head and neck squamous cell carcinoma patients. However, few studies specifically address the subgroup of patients with no clinical evidence of nodal disease.

Valoración de la reacción emocional provocada por la prueba vestibular calórica mediante monitorización de variables fisiológicas

Introduction and objectives

The emotional evaluation of the causes of vertigo is made using the clinical records and several subjective questionnaires. The aim of the present study is to evaluate the emotional response objectively, in normal subjects, during an induced vertigo crisis.

Unidad de Atención al Paciente Traqueostomizado. Una solución innovadora desde Otorrinolaringología con carácter transversal para el hospital

Background and objectiveThe care of tracheostomized patients are high risk skills and low incidence. Strategies for improvement of health care in hospital wards and specialties other than otolaryngology based solely on training have not been able to offer an adequate solution. A tracheostomized patient unit is presented directed by the otolaryngology service to attend all tracheostomized hospitalized patients of all specialties.Material and methodsBackground: Third level public hospital with 876 hospitalization beds and 30 ICU beds for 481,296 inhabitants. Unit model: Transversal unit for the hospital providing attention to all tracheostomized patients, adults, and children, of all specialties, with dedication of 50% of a ENT nurse of hospitalization that moves to the hospitalization bed of the specialty of each patient and 50% of another office ENT nurse for ambulatory patients care, with the consultancy of an ENT specialist and coordinated by the ENT supervisor.Results572 patients between 2016 and 2021, 80% men, aged 63 ± 14 years, were attended in the unit. 14.7 ± 2 tracheostomized patients daily and 96 ± 4 complication annual consultations were attended, rising up to 19 tracheostomized patients daily by 2020 and 141 ± 8.4 consultations by complications in 2020 and 2021, during the COVID-19 pandemic. The mean stay of the non-ENT specialties was reduced in 13 days, increasing the satisfaction of the ENT and non-ENT professionals and the satisfaction of the users.ConclusionsA Tracheostomized Patient Care Unit proactively directed from the Otorhinolaryngology Service to transversally care for all tracheostomized patients improves the quality of health care by reducing stay, complications, and emergencies. Improves the satisfaction of non-otolaryngological professionals by reducing the anxiety of facing care of patients who lack knowledge and experience and that of ENT specialists and nurses by reducing unplanned extemporaneous demands for care. Improves user satisfaction by perceiving adequate continuity of care. The Otorhinolaryngology Services provide their experience in the management of laryngectomized and tracheostomized patients and in teamwork with other specialists and professionals without the need to create new structures outside otorhinolaryngology.     

Papel de la resonancia magnética de difusión en el diagnóstico y seguimiento del colesteatoma. Estudio con la técnica PROPELLER difusión

Introduction and objectivesThe diagnosis of cholesteatoma is based on clinical evaluation and computed tomography. New non-echo-planar diffusion-weighted magnetic resonance imaging (MRI) techniques, without intravenous contrast, are capable of differentiating cholesteatoma from inflammatory tissue, cholesterol granuloma and granulation tissues. The technique is very helpful in differential diagnosis of cholesteatoma, mainly after canal wall-up tympanoplasty surgery, to avoid routine second-look surgery in these patients. Congenital cholesteatoma and difficult cases can be detected and correctly diagnosed as well. The aim of this study was to evaluate sensitivity, specificity, positive predictive value and negative predictive value of the diffusion-weighted PROPELLER MRI in cholesteatoma diagnosis.MethodsA prospective study was performed on 52 patients. Clinical and surgical findings were correlated with diffusion-weighted PROPELLER MRI results.ResultsSensitivity, specificity and positive and negative predictive values were 92.85%, 92.30, 92.85 and 92.30%, respectively.ConclusionsDiffusion-weighted PROPELLER imaging is an effective technique in cholesteatoma diagnosis. It is capable of detecting lesions larger than 2 mm.     

Colonización benigna sinusal por mucor asociada a desviación septal

Mucormycosis is a well recognised opportunistic infection caused by saprophytic fungi of the mucoraceae family. usually, the upper aerodigestive tract is the portal of entry. patients who are debilitated or inmunosuppresed might present with these infections, although sometimes can happen in patients with good health. we present a case of benign mucor colonitation at the sinus maxillary associated a deviated nasal septum     

Decanulación y evaluación de la deglución del paciente traqueotomizado en cuidados intensivos no-neurocríticos

With intensive care patients, decannulation and deglutition disorders are frequent reasons for otorhinolaryngological assessment.The objective of a tracheostomy is to maintain a patent airway. It does not necessarily prevent episodes of aspiration and may even favour them. When the cause that led to the tracheostomy resolves, a decannulation may be proposed.Deglutition is a complex act involving the coordinated interaction of several structures of the aerodigestive tract. Fibre-optic endoscopy and videofluoroscopy are 2 useful, complementary tools for the evaluation of patients with swallowing disorders. In managing these patients, a thorough knowledge of laryngeal and swallowing physiology, as well as of the different therapeutic alternatives, is required.Although it is not uncommon for swallowing disorders to coexist in tracheostomy patients, decannulation evaluation is not synonymous with deglutition assessment. A patient could be a candidate for decannulation and have a swallowing disorder, or a tracheostomy patient could swallow adequately.Knowing and understanding these concepts will lead to more efficient management and help to clarify communication between the intensive care physician and the otorhinolaryngologist. Ideally, a multidisciplinary team should be formed to evaluate and manage these patients.     

Manifestaciones audiovestibulares en pacientes con paquimeningitis hipertrófica idiopática: Revisión sistemática de la literatura

Background and objectiveHypertrophic pachymeningitis is an infrequent inflammatory disease resulting in thickening and fibrosis of the dura mater. In most cases, the cause in unknown and is called idiopathic hypertrophic pachymeningitis (IHP). Audiovestibular symptoms are infrequent and the pathogenesis is still unclear.Materials and methodsA systematic literature review of cases with IHP and vestibular symptoms from 2000 to February 2020 was performed. PRISMA Checklist was followed and PubMED database, Web of Science and Cochrane library were searched. We report a case of an adolescent with a diagnosis of vestibular neuritis in the context of IHP attended in our clinic.ResultsWe reviewed 5 articles related to IHP and vestibular disorders. A total of 7 cases (5 women and 2 men), with ages between 27 and 68 years with IHP were found. They all had audiovestibular symptoms. In contrast to our patient, uni or bilateral neurosensorial hearing loss was reported in all cases. Furthermore, there is no other case report published describing the association between IHP and vestibular neuritis. High dose steroids improved symptoms in 85.7% of the patients.ConclusionVestibular symptoms in IHP are uncommon and the pathogenesis is still debatable. Entrapment of nerves in the internal auditory canal and secondary neuronal damage could be suspected as the main cause of hearing and vestibular loss.