Impact of COVID-19 pandemic on the number of otolaryngologic surgeries in Japan.

OBJECTIVE: Previous studies show that the COVID-19 pandemic affected the number of surgeries performed. However, data on the association between the COVID-19 pandemic and otolaryngologic surgeries according to subspecialties are lacking. This study was performed to evaluate the impact of the COVID-19 pandemic on various types of otolaryngologic surgeries. METHODS: We retrospectively identified patients who underwent otolaryngologic surgeries from April 2018 to February 2021 using a Japanese national inpatient database. We performed interrupted time-series analyses before and after April 2020 to evaluate the number of otolaryngologic surgeries performed. The Japanese government declared its first state of emergency during the COVID-19 pandemic in April 2020. RESULTS: We obtained data on 348,351 otolaryngologic surgeries. Interrupted time-series analysis showed a significant decrease in the number of overall otolaryngologic surgeries in April 2020 (-3619 surgeries per month; 95% confidence interval, -5555 to -1683; p < 0.001). Removal of foreign bodies and head and neck cancer surgery were not affected by the COVID-19 pandemic. In the post-COVID-19 period, the number of otolaryngologic surgeries, except for ear and upper airway surgeries, increased significantly. The number of tracheostomies and peritonsillar abscess incisions did not significantly decrease during the COVID-19 pandemic. CONCLUSION: The COVID-19 pandemic was associated with a decrease in the overall number of otolaryngologic surgeries, but the trend differed among subspecialties.

Elective Surgery Trends and Outcomes of Nonagenarians and Centenarians in Otolaryngology-Head and Neck Surgery: A NSQIP Study.

OBJECTIVE: To describe types and outcomes of elective otolaryngological surgeries undergone by patients ≥90 years of age and to assess whether very old age is an independent risk factor for postsurgical complications and death. METHODS: The National Surgical Quality Improvement Program, a validated national prospective surgical outcomes database, was used to identify all patients aged 65 years and older who underwent elective otolaryngological procedures from 2011 to 2020. Study outcomes included minor complications, major life-threatening complications, and 30-day mortality. Predictors of outcomes, including frailty, were identified using univariable analyses and age was added into the final logistic regression models with stepwise selection. RESULTS: A total of 40,723 patients met inclusion criteria; 629 (1.5%) patients were ≥90 years of age. Of the 63,389 procedures, head and neck (67.6%) and facial plastics and reconstructive (15.0%) procedures were most common. The overall incidence of major life-threatening complications, minor complications, and death was 2.0%, 3.5%, and 0.4%, respectively. Age ≥90 was significantly associated with an increased risk for 30-day mortality, but not with major or minor postoperative complications. A high modified frailty index was significantly associated with an increased risk for major postoperative complications and death amongst patients ≥90 years. CONCLUSIONS: Elective otolaryngological surgery can be safe in relatively healthy nonagenarians and centenarians, though there is a small increased risk of 30-day mortality. Although older age can predispose patients to other comorbidities, age alone should not deter surgeons and patients from considering elective otolaryngological procedures. Frailty may be a better predictor for surgical outcomes. LEVEL OF EVIDENCE: IV Laryngoscope, 134:3989-3996, 2024.

'Seeing is believing' - gender disparities in otolaryngology-head and neck surgery in Africa: a narrative review.

PURPOSE OF REVIEW: Various factors affect otolaryngology - head and neck surgery (OHNS) services in low- and middle-income countries (LMICs); including inadequate infrastructure, limited academic positions, unfavorable hospital research policies, and traditional misconceptions about gender and surgery, among others. Although gender inequalities exist globally, they are particularly pronounced in LMICs, especially in Africa. RECENT FINDINGS: A comparative narrative literature review for relevant manuscripts from January 1, 2017 to through January 10th, 2024, using PubMed, Embase and Google Scholar for articles from the United States/Canada and Africa was done. 195 relevant articles were from the United States/Canada, while only 5 were from Africa and only 1 manuscript was relevant to OHNS. The reviewed articles reported that gender disparities exist in medical training, authorship, and career advancement. We highlight possible solutions to some of these disparities to promote a more gender-diversified workforce in OHNS in Africa as well as all over the world. SUMMARY: Additional studies on gender disparities in Africa, are needed. These studies will highlight need for inclusive policies, structured and accessible mentorship programs; through which these disparities can be highlighted and addressed. This will in the long run ensure sustainability of OHNS care in LMICs.

Experiencia en pacientes operados de roncopatía y apnea obstructiva del sueño / Clinical experience in patients with surgery of rhonchopathy and obstructive sleep apnea syndrome

RESUMEN Introducción: La uvulopalatofaringoplastía (UPPP) es un procedimiento ampliamente difundido en el tratamiento del ronquido y el síndrome de apnea e hipopnea obstructiva del sueño (SAHOS), ya que permite aumentar el área de sección transversal de la vía aérea superior y eliminar tejidos obstructivos. Conocer el grado de satisfacción de los pacientes con la cirugía es importante para nuestro desempeño. Objetivo: Evaluar la satisfacción de los pacientes con el procedimiento UPPP con cirugía nasal con datos subjetivos mediante la aplicación de una encuesta para ser respondida de forma anónima. Material y método: Estudio observacional, descriptivo. Se envió vía email una encuesta de 4 preguntas cerradas creada en la plataforma online MonkeySurvey a los pacientes que fueron sometidos a UPPP (faringoplastía de relocalización) con cirugía nasal entre 2015 y 2016. Resultados: 27 pacientes respondieron la encuesta. Sesenta y seis coma seis por ciento tenían ronquido primario y/o SAHOS leve, 33,3% SAHOS severo. La edad media al momento de la cirugía fue 41 años. El tiempo de seguimiento medio fue 10 meses (324 meses). Noventa y dos coma cinco por ciento de los pacientes están satisfechos con la cirugía UPPP; 81,4% refieren que recomendarían la cirugía a otra persona. Noventa y dos coma cinco por ciento refieren mejoría en los ronquidos. Noventa y cinco coma seis por ciento de los pacientes con somnolencia diurna refiere mejoría. Conclusión: La cirugía UPPP con técnica faringoplastía de relocalización combinada con cirugía nasal en pacientes con ronquido primario y SAHOS ha demostrado una alta tasa de satisfacción según la percepción de los pacientes en el seguimiento desde los 3 meses hasta los 2 años posoperatorios.

ABSTRACT Introduction: Uvulopalatopharyngoplasty (UPPP) is a widely used surgical procedure for snoring and obstructive sleep apnea syndrome (OSAS), since it allows to increase of the cross-sectional area of the upper airway and elimination of obstructive tissues. Knowing the degree of satisfaction of patients with surgery is important for our performance. Aim: To evaluate patient satisfaction with UPPP procedure (relocation pharyngoplasty) with nasal surgery with subjective data through the application of a survey to be answered anonymously. Material and method: Observational, descriptive study. A survey of 4 closed questions created in the MonkeySurvey online platform was sent to patients who underwent UPPP with nasal surgery between 2015 and 2016 via email. Results: 27 patients answered the survey. 66.6% had primary snoring and/or mild OSAS, 33.3% severe OSAS. The average age at the time of surgery was 41 years. The mean follow-up time was 10 months (3-24 months). 92.5% of patients are satisfied with UPPP surgery; 81.4% reported that they would recommend surgery to another person. 92.5% reported improvement in snoring. 95.6% of patients with daytime somnolence reported improvement. Conclusion: UPPP surgery with relocation pharyngoplasty technique combined with nasal surgery in patients with primary snoring and OSAS has shown a high satisfaction rate according to the perception of patients at follow-up from 3 months to 2 years postoperative.

Resección transoral-transnasal de tumores del espacio parafaríngeo / Transoral-transnasal approach to parapharyngeal space tumors

Objetivos: Determinar la tasa de resección quirúrgica completa en tumores seleccionados del Espacio parafaríngeo tratados por vía transoral o transnasal o por ambas. Diseño: descriptivo, retrospectivo. Materiales y métodos: Se incluyeron en este estudio los pacientes que tuvieron neoplasias localizadas en el espacio parafaríngeo y que fueron tratados con cirugía por vía transoral o transnasal. El abordaje transoral consistió en realizar una incisión con cauterio en la zona de mayor protrusión del tumor (pilar amigdalino y paladar), disección de la mucosa y del tumor de los planos profundos, traccionándolo hacia la cavidad oral. Para disecar el límite superior (rinofaringe) y lateral se utilizaron endoscopios que fueron introducidos por la incisión y por la cavidad nasal. El abordaje transnasal consistió en realizar una incisión en la pared lateral de la rinofaringe y disecar el tumor del plano profundo traccionándolo hacia el cavum. Resultados: Fueron tratados 3 pacientes por vía transoral y uno por vía endonasal por padecer tumores del espacio parafaríngeo. Tres tumores se originaron en glándulas salivales menores localizadas una en el espacio. Preestiloideo (1/3), otra en el espacio masticador (1/3) y otra en el sector superior del espacio preestiloideo (1/3). La histología dio como resultado dos adenoma pleomorfo y un carcinoma mucoepidermoide de bajo grado (1/3). (Está bien así? Qué es 1/3?). Una neoplasia se originó en el lóbulo profundo de la parótida y se extendió al espacio preestiloideo, su histología fue carcinoma mucoepidermoide de grado moderado. Conclusiones: La tasa de resección completa en pacientes con tumores del espacio parafaríngeo seleccionados tratados por vía transoral y endonasal fue del 100%. (AU)

Objectives: To determine the rate of complete surgical resection in parapharyngeal space selected tumors treated with transoral and / or transnasal approach. Design: Descriptive, retrospective. Materials and methods: Patients who had tumors localized in parapharyngealspace and who were treated with transoral or transnasal surgery. were included in this study. The transoral approach consisted in performing an incision with cautery in the area of greates tumor protrusion (tonsillar pillar and palate), dissection of the mucosa and tumor of the deep planes, pulling it into the oral cavity. To dissect the upper limit (nasopharynx) and lateral we used endoscopes that were inserted by the incision and the nasal cavity. The transnasal approach consisted in making an incision in the side wall of the nasopharynx and dissect the tumor of the deep plane pulling it towards the cavum. Results: Three patients were treated with transoral and one byendonasalapproacheswho had parapharyngeal space tumors. Three tumors originated in minor salivary glands located in prestyloidspace (1/3), masticator space (1/3) and upper sector of pree-styloid space (1/3). Histology was in two pleomorphic adenoma, and another onelow degree mucoepidermoid carcinoma (1/3). A neoplasm was originated in the deep lobe of the parotid gland and was extended to the prestyloid space, was a moderate degree of mucoepidermoid carcinoma. Conclusions: Complete resection rate in patients with selected parapharyngeal space tumors, treated by transorally and endonasal approach was 100%. (AU)

Resultados en cirugía mayor ambulatoria en otorrinolaringología realizada en un hospital de baja complejidad / Results in major ambulatory surgery in otorhinolaryngology performed in a hospital of low complexity

Introducción: La cirugía mayor ambulatoria confiere al sistema sanitario un modelo de gestión eficiente y de alta calidad. Objetivo: Conocer los resultados de la cirugía mayor ambulatoria en otorrinolaringología (ORL) en un hospital de baja complejidad. Material y método: Estudio descriptivo retrospectivo realizado en el Hospital Santo Tomás de Limache entre los años 2004 y 2009. La inclusión de pacientes sometidos a cirugía otorrinolaringológica bajo la modalidad de cirugía mayor ambulatoria. Se realizó análisis descriptivo en base a promedios, desviación estándary proporciones. En análisis bivariado, se emplearon las pruebas de chi cuadrado y t-student. Resultados: Se incorporó 815 pacientes. El 58% fue de sexo masculino, con edad promedio de 8,4 ±6,2 años. La adenoamigdalectomía sola o asociada a otras cirugías se efectuó en 54,2(0)% de los casos. La tasa de complicaciones posoperatorias fue de 1,22 %, la mitad de ella, la hemorragia. No hubo mortalidad. No se encontró asociación estadística entre la presencia de complicaciones y alguna variable en particular. Conclusiones: En pacientes de otorrinolaringología seleccionados, la cirugía mayor ambulatoria efectuada en un hospital de baja complejidad tiene buenos resultados, con una baja tasa de complicaciones.

Background: Major ambulatroy surgery provide to public health and efficient and high quality model. Aim: To know teh results in patient underwent Otorrinolaringologic surgery in a low complexity hospital. Material and method: Date from 815 who underwent Otorrinolaringologic surgery carried on a major ambulatory surgery basis in Hospital Santo Tomás de Limache, between 2004 and 2009 where retrospectively reviewed. Analysed date included sex, age, type of conducted surgery, type of complications and the period of time in which patients were discharged. Averages, standard deviation and proportions were used. In bivariate analysis, chi square and t-student were used. Results: 58% of enrolled patients were males with age average of 8.4 ±6.2 years. Adenotonsillectomy single or associated to other surgeries took place in 54,2% of the cases. The rate ofpostoperation side effects was 1.22%%, And half of these patient presented postoperatory bleeding. There was no mortality. There was not statistical association between the presence of complications and some variable in particular. Conclusions: Major ambulatory surgery In selected patients who need otorrinolaringologic surgery in a low complexity hospital is safe whith low rate of complication.

Experiencia quirúrgica del Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital Guillermo Grant Benavente durante el periodo 2007-2011 / Surgical experience of the Department of Otolaryngology and Head and Neck Surgery from Guillermo Grant Benavente Hospital

Introducción: Nuestra especialidad plantea una amplia gama de polos de perfeccionamiento medicoquirúrgico. Es necesario conocer la situación actual de nuestros servicios, en base a lo cual poder delinear futuras áreas de desarrollo. Objetivo: Conocer la experiencia quirúrgica del Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello del Hospital Guillermo Grant Benavente. Material y método: Estudio observacional retrospectivo. Análisis de libros de pabellón, protocolos quirúrgicos e información estadística del centro durante los años 2007-2011. Resultados: Se realizaron 8.262 cirugías durante el periodo estudiado, con un promedio de 1.921 cirugías anuales. Las áreas quirúrgicas más prevalentes son faringe (44%), rinosinusología (18%) y otología (17%). Discusión: En nuestro centro se desarrolla una amplia y variada gama de procedimientos quirúrgicos. Existen áreas de un significativo potencial de desarrollo, tales como la cirugía endoscópica rinosinusal y la cirugía de cabeza y cuello.

Introduction: Our specialty poses a wide range of medical and surgical areas of improvement. We need to know the current status of our services to delineate future development areas. Aim: To determine the surgical experience of the Department of Otolaryngology and Head and Neck Surgery from Guillermo Grant Benavente Hospital. Material and method: Retrospective observational study. Surgery room books, surgical protocols and statistical information center reviews. Results: We performed 8262 surgeries during the study period, with an average of 1921 surgeries annually. The most prevalent surgical areas are Pharynx (44%%), Rhinosinusal (18%) and Otology (17%). Conclusions: In our center, we developed a wide and varied range of surgical procedures. There are areas of significant development potential, such as endoscopic rhinosinusal and head and neck surgery.

Cirugía para el manejo del síndrome de apnea e hipopnea obstructiva del sueño y de la roncopatía: revisión de 71 casos clínicos / Surgery in the management of obstructive sleep apnea and hypopnea syndrome and snoring: review of 71 clinical cases

Introducción: El síndrome de apnea e hipoapnea obstructiva del sueño (SAHOS) es una patología altamente prevalente y se asocia a importante comorbilidad cardiovascular. Su etiología es multifactorial. Dentro de las opciones terapéuticas, la cirugía de la vía aérea superior es una alternativa efectiva en casos seleccionados. Objetivo: Describir la experiencia del Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile en cirugía de pacientes con diagnóstico de SAHOS. Material y método: Estudio retrospectivo descriptivo. Se analizan fichas clínicas, antecedentes demográficos y mórbidos, polisomnografía (PSG), tipo de cirugía, puntaje de Epworth pre y posoperatorio, estadía hospitalaria, complicaciones y seguimiento. Resultados: De un total de 71 pacientes (87 por ciento de sexo masculino, edad promedio de 44 años), el 88 por ciento por ciento tiene diagnóstico preoperatorio de sobrepeso u obesidad. Al 67 por ciento por ciento de los pacientes se les realizó PSG, en el 64 por ciento por ciento de ellas se demostró un SAHOS moderado a severo. En el 97 por ciento por ciento de los casos se realizó uvulopalatoplastía con radiofrecuencia (UPP), en el 62 por ciento por ciento septoplastía (SP) y en el 50 por ciento por ciento amigdalectomía. En el 98 por ciento por ciento de los pacientes se asociaron 2 a 4 técnicas, destacando la SP más UPP como la combinación más frecuente (15,45 por ciento por ciento). El promedio de estadía hospitalaria fue de 1,09 días. Sólo el 7 por ciento de los pacientes presentó complicaciones. El seguimiento promedio fue de 3,05 meses. Discusión: El rol de la cirugía es eliminar el colapso de la vía aérea superior, lo que se logra en la mayoría de los pacientes usando técnicas asociadas. Conclusión: La indicación de cirugía en SAHOS debiera combinar diferentes técnicas dependiendo de la localización anatómica de la obstrucción y el tipo de paciente a intervenir.

Introduction: The obstructive sleep apnea syndrome (OSA) is a highly prevalent disease and is associated with significant cardiovascular morbidity. Its etiology is multifactorial. Among the therapeutic options, surgery of the upper airway is an effective alternative in selected cases. Aim: To describe the experience of the Otorhinolaryngology Service of Hospital of the University of Chile in surgery of patients with OSA. Material and method: Retrospective descriptive study. We analyzed clinical and morbid records, demographic background, polysomnography (PSG), type of surgery, pre and post surgical Epworth scores, hospital stay, complications and follow-up. Results: Of a total of 71 patients (87 percent male, average age of 44 years), 88 percent had a preoperative diagnosis of overweight or obesity. 67 percent of patients were done a PSG, 64 percent of them showed a moderate to severe OSA. 97 percent of patients underwent radiofrequency uvulopalatoplasty (UPP), 62 percent septoplasty (SP) and 50 percent tonsillectomy. In 98 percent of patients, 2 to 4 associated techniques were used, highlighting the association of UPP plus SP as the most frequent combination (15.45 percent percent). The average hospital stay was 1.09 days. Only 7 percent percent of patients had complications. The average follow-up time was 3.05 months. Discussion: The role of surgery is to remove the collapse of the upper airway, which is achieved in most patients using associated techniques. Conclusion: Surgery for OSA should include different techniques combination, anatomical location of obstruction and patient's profile.

Estenosis laringotraqueal: experiencia clínica / Laryngo-tracheal stenosis: our experience

Introducción: La estenosis laringotraqueal es una patología de difícil manejo y obtener un resultado que permita, al sujeto que la padece, volver a tener una función adecuada fonorrespiratoria y deglutoria, no siempre es factible de obtener. Objetivo: Presentar una serie clínica de pacientes que tienen una estenosis de la vía aérea superior (VAS) y que fueron intervenidos quirúrgicamente. Como objetivo secundario es evaluar si a técnicas similares hay o no diferencias entre los grupos etarios. Material y método: Presentamos un análisis retrospectivo de los pacientes intervenidos quirúrgicamente por los autores. En él se realiza la descripción demográfica de los casos, sitio de la estenosis, tipo de intervención según edad; porcentaje de éxito en la decanulación después de una o varias intervenciones, necesidad de reoperación, tipo de injerto y tutores utilizados. Se dividió el grupo en pediátrico (hasta los 18 años) y adulto (mayores de 19 años). Los resultados fueron analizados con las pruebas no paramétricas de x² y de Fisher. Resultados: La casuística consta de 88 pacientes intervenidos quirúrgicamente para reparar una estenosis laringotraqueal. Los menores de 18 años corresponden a 45 casos (51 por ciento). El porcentaje de éxito alcanzado en la primera cirugía es de 75,6 por ciento (34/45 casos) en los menores de 18 años y de 76,7 por ciento por ciento (33/43 casos) en los mayores de 19 años. Se reoperan 15/21 casos fracasados en primera instancia; logrando decanular a 13 de ellos aumentando el éxito a 90,9° por ciento. Fracasan a las reoperaciones y pendientes de resolver aún, 8 casos. La técnica más utilizada fue la reconstrucción laringotraqueal con injerto de cartílago costal ya sea anterior y/o posterior, por ser la estenosis subglótica el sitio de la lesión. El porcentaje de éxito para esta técnica es de 68,3 por ciento; siendo en los menores de...

Introduction: Laryngo-tracheal stenosis is a condition difficult to manage and obtain results which permit the person who suffers it recover phonorespiratory and deglutory function. This is not always possible to achieve. Aim: Present a clinical series of patients with stenosis of the VAS and underwent surgery. A secondary objective is to assess whether or not there are similar technical differences between age groups. Material and method: We present a retrospective analysis of patients surgically treated by the authors. They present demographic description cases, site of stenosis, type of intervention according to age; percentage of successful decannulation after one or more interventions; reoperation, type of graft and stents used. The group was divided into pediatric and adult. Statistical analysis was performed with x2 and Fisher. Results: The case mix consists of 88 patients who underwent surgery to repair laryngo-tracheal stenosis. Children under 18 years correspond to 45 cases (51 percent percent). The percentage of success in the first surgery is 75.6 percent percent (34/45 cases) in children under 18 and 76.7 percent percent (33/43 cases) over 19years. 15/21 failed cases were reoperated in the first instance; 13 of them were decannulated increasing success to 90.9 percent percent. Reoperation failure and still unresolved, 8 cases. Surgical technique used was laryngotracheal reconstruction with costal cartilage graft either anterior or posterior being subglottic the site of stenosis. Success rate to this technique is 68.3 percent percent. In patients under 18 years old is 71 percent percent success and over 18 years 60 percent percent. For tracheal stenosis, tracheal resection with end to end anastomosis has a success rate of over 90 percent and it is performed mostly in the age group over 18 years...

Epidemiología y resultado estético funcional de la reducción de la fractura nasal / Epidemiology and aesthetic and functional outcome in nasal bone fracture reduction

Introducción: Las lesiones faciales traumáticas más frecuentes son las fracturas nasales debido a la prominencia de la pirámide nasal. Existe cierto consenso en que cuanto antes se intente su reducción más posibilidades existen de obtener un resultado exitoso. Objetivo: Describir epidemiológicamente y evaluar los resultados funcionales y estéticos de las fracturas. Material y método: Se revisaron las fichas clínicas de los pacientes para describir los datos epidemiológicos, se realizó la encuesta SNOT-22 para evaluar los resultados funcionales y una encuesta cualitativa para la percepción estética de las reducciones. Resultados: De un total de 42 pacientes, predominó el sexo masculino 6:1, la edad promedio fue de 34,4 años. El 83,3 por ciento de la reducciones se realizó en policlínico con anestesia local y el procedimiento se realizó en promedio 8,6 días posfractura. Sobre el resultado funcional destaca la obstrucción nasal posreducción en 43,6 por ciento con un puntaje SNOT-22 promedio de 46,9 puntos y el 47,62 por ciento> consideró su resultado estético como peor. Discusión: Consideramos el resultado estético funcional como no satisfactorio, por lo que no sería inadecuado realizar cirugía de rinoseptoplastía inmediata o diferida para mejorar el resultado.

Introduction: Nasal fractures are the most common facial injuries because ol the prominence of the nose. There is some consensus that the sooner you try their reduction more likely is a successful outcome. Aim: Epidemiologically describe and evaluate functional and aesthetic results of nasal fractures. Material and method: We reviewed the medical records of patients to describe the epidemiológical data, perform the SNOT-22 survey to evaluate the functional results and a qualitative survey for aesthetic perception of the reductions. Results: Of a total of 42 patients, males predominated 6:1, average age was 34.4 years. 83.3 percent of the reductions took place in clinic with local anesthesia and the procedure was performed on average 8.6 days post-fracture. With regard to functional outcome highlights only nasal obstruction after reduction of 43.6 percent with a SNOT-22 scoring average of 46.9 points and 47.62 percent of patients considered a worse cosmetic outcome. Discussion: We believe that the functional and aesthetic result is not satisfactory, so we would recommend a septorhinoplasty immediate or detened for better results.

Is the information available on the Web influencing the way parents see ENT surgical procedures? / Informações da internet estão influenciando a decisão dos pais na realização de cirurgias otorrinolaringológicas?

INTRODUCTION AND AIMS: the Internet is the world's fastest growing source of health related information. Parents and guardians are increasingly turning to the Internet for information about their children's medical conditions and treatments. This paper has the following objectives 1) determine the prevalence of web searches for medical information performed by parents/guardians of children undergoing ENT surgery in a private hospital of Sao Paulo, Brazil. 2) assess whether the gathered information influenced the parents/guardians' decision on the treatment/surgery. METHOD: questionnaire voluntarily responded by 132 parents/guardians of children submitted to ENT surgery in a private hospital in Sao Paulo, Brazil. CONCLUSIONS: 117 parents/guardians (90 percent) used the Internet to search for information on the disease and surgical treatment of the children. Only 12 parents/guardians (10 percent) discussed the information with the physician assigned to perform the surgical procedure. 91 parents/guardians (78 percent) said that the information had impact upon the decision to have surgery performed on their children.

INTRODUÇÃO E OBJETIVOS: A Internet é a fonte de informação relacionada à saúde que mais cresce atualmente. Pais ou responsáveis estão cada vez mais buscando a rede mundial de computadores para pesquisa sobre doenças e tratamentos para filhos ou dependentes. Nosso trabalho tem por objetivos: 1) determinar a prevalência de procura sobre informações médicas na Internet por pais/responsáveis de crianças submetidas a cirurgias otorrinolaringológicas em hospital privado de São Paulo, Brasil. 2) avaliar se estas informações influenciaram os pais/responsáveis quanto à decisão médica. MÉTODO: Questionário respondido voluntariamente por 132 pais/responsáveis de crianças submetidas a cirurgias otorrinolaringológicas em hospital privado de São Paulo, Brasil. CONCLUSÕES: 117 pais (90 por cento) utilizaram a Internet para procurar informações sobre a doença e tratamento cirúrgico dos filhos. Somente 12 parentes (10 por cento) discutiram as informações adquiridas com o médico que realizou o procedimento cirúrgico. Entretanto, 91 (78 por cento) afirmaram que as informações influenciaram as decisões sobre os procedimentos a serem realizados em filhos/dependentes. Otorrinolaringologistas devem estar conscientes do crescente uso da Internet como fonte de informações médicas e do conteúdo de páginas específicas com informações confiáveis e de fácil acesso para direcionarem pacientes, além de discutirem estas informações.

Técnica de Caldwell-Luc en los últimos 16 años: revisión de sus indicaciones / The Caldwell-Luc procedure in the last 16 years: a review of its clinical indications

Introducción: En una época marcada por el abordaje endoscópico del seno maxilar principalmente en casos de sinusitis crónica, la técnica clásica de Caldwell-Luc ha quedado relegada a una situación casi de 'recuerdo del pasado'. Sin embargo, evidencias recientes llaman a rescatar la utilidad de este procedimiento frente a fracasos de cirugías endoscópicas funcionales sinusales, especialmente relacionadas con una entidad conocida como 'cambios irreversibles de la mucosa'. Objetivo: Reflexionar sobre las indicaciones de esta técnica en nuestro centro, comparándolas con las nuevas perspectivas esbozadas en la literatura mundial. Material y Método: Se presenta una revisión de la literatura al respecto, junto con la casuística del Servicio de Otorrinolaringología del Hospital San Juan de Dios. Resultado: Entre 1992 y 2007 se realizaron 56 cirugías Caldwell-Luc. La principal indicación fue la resolución de sinusitis crónica maxilar, aunque en relación a situaciones que se alejan de los motivos propuestos en la literatura para elegir este procedimiento. Esto, junto a una alta tasa de recidiva sintomática (21,4% de los pacientes operados entre 1997 y 2007 cumplen criterios para sinusitis crónica actual) y elevadas tasas de complicaciones (31,8%) nos llevan a reflexionar sobre el uso que se ha dado a esta técnica en nuestro centro. Conclusión: Se concluye que este procedimiento continúa vigente, y quizás siendo irremplazable, especialmente en el manejo de patología sinusal crónica con cambios irreversibles en su mucosa, concepto sin una definición precisa y sobre el cual comentamos en detalle.

Introduction. Since the introduction of the endoscopic approach to the maxillary sinus, Caldwell-Luc's classic technique has been relegated to an almost 'memory of the past' category. Yet, recent evidence urges to rescue this procedure in view of its usefulness in cases of failed functional endoscopic sinus surgery especially related to an entity known as 'irreversible mucosa changes'. Aim. To review the indications for this technique in our department, comparing our data with that from recent literature. Results. We present 56 Caldwell-Luc procedures and a literature review on the subject. The procedures were performed between 1992 and 2007 at the ENT Department of San Juan de Dios Hospital. Chronic sinusitis remained the main indication, but within scenarios that differ from those regarded in the current literature as indicative of the technique. This, along with a large symptomatic relapse rate (21.4% of patients operated between 1997 and 2007 met criteria for current chronic sinusitis), and high complications rate (31.8%) within our cases, lead us to question the indications for the procedure in our department. Conclusion. We conclude that this procedure remains in force, and is perhaps even irreplaceable, particularly in the management of chronic sinus disease with irreversible mucosa changes, an ill-defined concept, which we discuss in detail.

Programa quirúrgico para residentes de otorrinolaringología: de la teoría a la práctica / Surgical training program for ORL residents: from theory to practice

Introducción: La formación de médicos especialistas en Otorrinolaringología es una necesidad en nuestro país, lo que debe incluir un aprendizaje de contenidos teóricos y adquisición de habilidades prácticas. Objetivo: Evaluar el cumplimiento de los objetivos prácticos planteados por el programa de formación de especialistas de la Escuela de Postgrado de la Universidad de Chile. Material y método: Estudio retrospectivo, descriptivo a partir de los libros del pabellón del Servicio de Otorrinolaringología del Hospital San Juan de Dios, en el período 1996-2007. Resultados: El cumplimiento global de los objetivos es de 57,3%. Discusión y conclusión: Diversos factores pueden explicar el resultado. Consideramos el más importante la falta de actualización del programa a los avances tecnológicos de la especialidad y a la realidad epidemiológica nacional.

Introduction. Adequate specialty training in otorhinolaryngology should include both theoretical learning and the acquisition of practical skills. Aim. To assess the practical skills objectives reached by the medical specialty training program at the University of Chile Postgraduate School. Material and method. Retrospective and descriptive study based on the surgical ward medical records of the Otorhinolaryngology Department of San Juan de Dios Hospital, between 1996 and 2007. Results. The overall rate of objectives reached was 57,3%. Discussion and conclusion. Several factors may account for the results. Most important in our view is the Program failure to keep updated according to the specialty new technological advances and the local epidemiological reality.

Perfil de internamento por morbidade otorrinolaringológica com tratamento cirúrgico. Brasil, 2003 / Profile of hospitalizations due to otorhinolaryngologic morbidity requiring surgical treatment. Brazil, 2003

Objetivo: Analisar o perfil dos procedimentos cirúrgicos relacionados à otorrinolaringologia no Brasil no ano de 2003. Forma de Estudo: Trata-se de um estudo observacional, descritivo, transversal do tipo seccional. Métodos: Analisamos 80.030 procedimentos cirúrgicos nos 27 estados do Brasil no período compreendido entre janeiro e dezembro de 2003. Os dados foram obtidos do Sistema de Informação Hospitalar do Ministério da Saúde. O fator de inclusão se deu pela variável procedimento cirúrgico em otorrinolaringologia. Todos os arquivos foram processados pelo software TABWIN. Resultados: No ano 2003, no Brasil, foram realizados 80.030 procedimentos cirúrgicos relacionados à ORL. A Região Sudeste é a região com maior número de procedimentos (53,08%), seguida pela Região Sul e Nordeste com 19,6% e 15,6% respectivamente. Quanto ao grupo de procedimento as cirurgias da faringe representam 45% dos procedimentos em ORL. Os procedimentos de alta complexidade foram realizados em maior número no grupo de cirurgia de ouvido. Quanto à distribuição segundo tipo de prestador, observamos que existe uma maior concentração dos procedimentos cirúrgicos realizados nos hospitais filantrópicos, seguido dos públicos estaduais e universitários. A Tabela adotada pelo SUS para pagamento de procedimentos cirúrgicos em ORL não se encontra atualizada para os procedimentos hoje realizados, repercutindo na notificação inapropriada de alguns tipos de cirurgias. Conclusão: Com o conhecimento do perfil dos internamentos cirúrgicos em ORL no Brasil, podem ser identificadas particularidades na distribuição quanto às diferentes regiões que podem auxiliar gestores de saúde à tomada de decisões no sentido de garantir os princípios preconizados pelo SUS no acesso aos serviços de saúde.

Aim: To analyze the profile of the surgical procedures related to otorhinolaryngology in Brazil in the year 2003. Study Design: This was an observational, descriptive, cross-sectional study. Methods: We analyzed 80,030 surgical procedures performed in 27 Brazilian States during the period from January to December 2003. The data were obtained from the Hospital Information System of the Ministry of Health. The inclusion factor was a surgical procedure in otorhinolaryngology (ORL). All files were processed with the TABWIN software. Results: In 2003, 80,030 ORL-related surgical procedures were performed in Brazil. The Southeast region had the largest number of procedures (53.08%), followed by the South and Northeast regions (19.6% and 15.6%, respectively). Regarding the group of procedures, surgeries of the pharynx represented 45% of ORL procedures. Procedures of high complexity were more numerous in the ear surgery group. Regarding the distribution of the type of attending institution, the highest concentration of surgical procedures occurred in philanthropic hospitals, followed by state and university public hospitals. The table adopted by SUS for payment of ORL surgical procedures has not been updated for the procedures currently performed, with the consequent inappropriate notification of some types of surgery. Conclusion: Knowledge about the profile of surgical hospitalizations related to ORL permits the identification of the peculiarities of the different regions that can help health-managing authorities to make decisions in order to guarantee the principles recommended by SUS regarding access to health services.

Evaluación de una unidad de cirugía de día / Evaluation of a day surgery unit

Objetivos. Presentar una evaluación de la Unidad de Cirugía del Día (UCD) del Centro de Asistencia del Sindicato Médico del Uruguay (CASMU) de Montevideo, instalada en el Sanatorio 1 de esta institución, un hospital de 107 camas destinado antes a la actividad quirúrgica de mediana y baja complejidad. Se analizan los resultados del proceso de reorganización de la actividad quirúrgica bajo el régimen de la cirugía de día mediante indicadores estadísticos de utilización del servicio, costos y satisfacción del paciente. Métodos. Se utilizaron las estadísticas asistenciales para determinar la cobertura del nuevo régimen, los días de internación, los costos anteriores y posteriores a la puesta en funcionamiento de la UCD y la opinión de los pacientes sobre la calidad de la atención. Resultados. Tras los primeros 2 años de funcionamiento de la UCD (1998-1999), más de un tercio de las operaciones de las especialidades seleccionadas se realizaban en el régimen de cirugía de día. Dichas especialidades representan 84 por ciento del total de las actividades quirúrgicas realizadas por la UCD. Los días de estadía en las especialidades incluidas en el sistema disminuyeron en 26 por ciento. El análisis de costo-efectividad de esta modalidad muestra resultados dos veces y media más favorables que la forma convencional. En general, los pacientes manifestaron gran satisfacción con los servicios prestados por la UCD. Discusión. Los resultados obtenidos permiten recomendar definitivamente esta forma de atención, dado que es de buena calidad, logra la satisfacción del paciente y reduce radicalmente los costos, gracias a la disminución de la estadía y de los recursos necesarios en los servicios de internación. Existen posibilidades de expansión de este nuevo régimen mediante la incorporación de otros procesos patológicos y de las técnicas elegibles

Objective. To evaluate the Day Surgery Unit (DSU) of the Medical Union of Uruguay Health Center (MUUHC), in Montevideo. The DSU is located in the MUUHC's Sanatorium 1 hospital, a 107-bed hospital that had previously handled low- and mediumcomplexity surgeries. The results of the reorganization of the surgical activity were analyzed in terms of service utilization, costs, and patient satisfaction. Methods. For four surgical specialties that were selected for study, health care data were gathered and used to determine the coverage level with the new approach, the number of days of hospitalization, the costs before and after putting the DSU into place, and the patients' opinions of the quality of the care. Results. For the 1998­1999 period, which was the second full year of operation of the DSU, the DSU was carrying out more than a third of the surgeries of the four surgical specialties being studied. These four specialties accounted for 84% of the total number of surgeries carried out by the DSU in the 1998­1999 period. The total number of days of hospitalization declined by 26%. The cost-effectiveness analysis showed that the conventional approach, with hospitalization, would have cost some two and a half times as much as the day surgery approach for the same surgeries. In general, the patients expressed strong satisfaction with the services they received from the DSU. Discussion. Our results indicate that it is definitively possible to recommend this day surgery form of care, since it provides good quality of care, it satisfies patients, and it dramatically lessens costs, thanks to the reduction in hospitalizations and the resources needed for inpatient services. It may be possible to expand this new regimen by including other conditions and surgical techniques that are appropriate for day surgeries

Otolaryngology--Head and Neck Surgery training in Puerto Rico

The Otolaryngology--Head and Neck Surgery training program of the University of Puerto Rico, Medical School, is enjoining a full accreditation by the Residency Review Committee of the Accreditation Council for Graduate Medical Education. Since its foundation 76 Otolaryngologist--Head Neck surgeons have graduated, the first class was in 1962 and the last in June 1998, ten of them moved to the mainland where they practice or teach in renown universities. Our program is five year's durations, and it includes one year of general surgery and four years of progressive education in the specialty. Experience in the surgical sciences will precede the otolaryngology--head and neck surgery education, two residents are accepted each year

Análisis de la atención intrahospitalaria del servicio de otorrinolaringología del Hospital Guillermo Grant Benavente de Concepción 1993-1997 / Analysis of intrahospitalary care at the otolaryngology departament of Guillermo Grant Benavente hospital, Concepción 1993-1997

Presentamos una análisis estadístico de los egresos e intervenciones quirúrgicas realizadas en el servicio de otorrinolaringología del Hospital Guillermo Grant Benavente de Concepción en el período 1993-1997. Se estudia un total de 8.275 egresos y 9.607 cirugías y/o procedimientos, analizando las características de los pacientes, patologías e intervenciones más frecuentes