Narrow band imaging endoscopy improves visualization of vessels of the perforated tympanic membrane.

PURPOSE: Because successful healing of a tympanic membrane perforation (TMP) depends upon the maintenance of blood supply to the injured area, we assessed the usefulness of narrow band imaging (NBI) video endoscopy to evaluate its vascularization. To our knowledge, the use of NBI to assess tympanic membrane (TM) vascular patterns has never been attempted. METHODS: Prospective observational study. NBI and cold white light (CWL) flexible videoendoscopy was used to explore perforated TMs of 100 patients. Main outcome measures were visualization of vessels among abnormal TM findings: monomeric areas (MA) (n = 6), myringosclerosis plaques (MP) (n = 65) and perforation edges (n = 100). They were graded by a vascular otoendoscopic score (VOS) comparing both types of lights (Wilcoxon test). Location and vascularization patterns were analyzed (Fisher's test). RESULTS: NBI was better to observe vascularization of 32% of perforation edges and 75.4% of MP (p < 0.001). NBI displayed higher (better) VOS when evaluating TMP edges (1.05 vs. 0.73) and MP (1.56 vs. 0.81, p < 0.001). The majority of TMP edges showed a ring pattern (66%), followed by irregular (19%), avascular (12%) and radial patterns (3%). The avascular pattern was more frequent in posterior perforations (p = 0.003). The radial pattern was most frequently found in MP, especially at posterior quadrants (p = 0.048). MA presented an irregular pattern in 83.3% of TMs. CONCLUSIONS: NBI videoendoscopy is a promising non-invasive technique, superior to CWL for visualizing vessels among TMP edges and MP, based on further study, could become a supplementary diagnostic tool in the workup of TMP and the decision-making surgical field.

Evaluation of resident's training for endoscopic sinus surgery using a sheep's head.

Training in functional endoscopic sinus surgery (FESS) is an essential part of each ENT resident and it takes place on a very fragile area. This study focus on showing the learning curve of FESS, using an anatomical model such as the sheep's head. Four residents in our centre performed dissections. Each of these residents operated eight sheep's head. They performed an endoscopic septoplasty followed by maxillary antrostomy, total ethmoidectomy and frontal sinusotomy on every head. A staff member guided all procedures and checked for the appropriate dissection and complications occurred. Analysis was made upon the residents' performance of their first four septoplasties and eight nasal sides against their subsequent performance of the same. Final procedures presented better outcomes than the initial ones on every step of them. Results were measured by means of decrease of time (P < 0.0001) and complications, showing no major complications on the latest ones. Sheep's head is a suitable substitute for the cadaveric human head, to obtain the surgical skills needed for FESS procedures. Sheep's nasal cavity allows gaining dexterity and it is an easy model to obtain.

[Primary myringoplasties. Results after a 2 year follow-up period]. / Miringoplastias primarias. Resultados a los 2 años de seguimiento.

INTRODUCTION AND GOALS: The goals of myringoplasty are closure of the perforation in the tympanic membrane and improvement in hearing levels, with varying results in the published literature. Our aim was to determine the results of this procedure at our centre and compare them with the literature. METHODS: Retrospective analysis of 217 primary myringoplasties carried out in the Otorhinolaryngology Department of the Ramón y Cajal University Hospital between 1998 and 2003, describing the characteristics of the perforations, surgical technique and post-operative results (perforation closure and hearing improvement). RESULTS: The majority were adults with perforations secondary to recurrent middle ear infections (91%). Most were less than subtotal (64%) and did not involve the tympanic annulus (79%). Grafts were inserted using lateral (45%), mixed (29%) and medial (26%) techniques, using retroauricular (66%) and endaural (34%) approaches. Temporal muscle fascia was the graft most frequently used (87%). Perforation closure was achieved in between 78% and 91% of cases throughout the 24-month follow-up period, with an overall closure value of 78% after 2 years of follow-up. Hearing improvement, established as an air bone gap difference of less than 20 dB, was seen in approximately 56% of cases. CONCLUSIONS: At our centre, myringoplasty achieves anatomical (78%) and functional (56%) success comparable to the results described in the literature. We consider medium-term follow-up to be of the utmost importance because of reperforation phenomena, which may occur as much as 2 years or more after surgery.

[Laryngotracheal NK/T lymphoma: clinical case]. / Linfoma T/NK laringotraqueal: caso clínico.

NK/T-cell lymphoma is a rare condition with an aggressive course and poor prognosis. Historically known as «lethal midline granuloma¼, it generally appears in a midfacial location. We describe the case of a 22-year-old Colombian woman with laryngotracheal affectation, presenting with hoarseness and hemoptysis. CT scan and MRI showed severe laryngeal and tracheal destruction. The biopsy showed a polymorphic, lymphoid cell infiltrate with angiocentric and angiodestructive pattern. The immunohistochemical study confirmed the immunophenotype of the NK/T-cells: CD2+, CD56+ and cytoplasmic CD3+. The in situ hybridization and flow cytometry findings were: EBER+, TIA-1+ and perforin+. The patient died from complications of her disease, before undergoing oncologic treatment.

[Demand and supply of otolaryngology specialists based on evidence: What is the required number of specialists who should be trained?]. / Demanda y oferta de otorrinolaringólogos basada en la evidencia: ¿cuál es el número necesario de especialistas que se deben formar?

Several concurrent circumstances have created an impression through the media of a presumed lack of specialists in Spain, which has one of the highest densities of doctors per population in the world: simultaneous creation of jobs in many newly built hospitals; accepting garbage contracts (for months, half/thirds of days, shifts) in relevant hospitals rather than moving to unattractive positions; full dedication to the field of public or private healthcare rather than matching them; bad public healthcare working conditions (low wages, excessive healthcare pressure, lack of respect from the public and from healthcare managers, shifts, scarce professional promotion, difficult family reunification); decreased mobility due to insulation of the markets as a result of decentralization of healthcare by regions. There is no shortage of specialists in otolaryngology, but instead there are sporadic inequalities in their geographical distribution. The current number of positions as training doctors offered annually is higher at the moment than the demand of the Spanish society, for specialists who have adapted smoothly to the requirements of the new medical practice: clinical management, care quality, technology-based efficiency, evidence-based medicine. The modification of working conditions through higher flexibility in the working models and an increase of salaries based on activity and quality will show that the otolaryngology workforce which is generated with the current offer can assume the present and future demand. A high quality of specialized otolaryngology training is the substrate to be improved, so that future otolaryngology specialists will be able to face health challenges without unduly increasing their number.

Acoustic analysis of voice using WPCVox: a comparative study with Multi Dimensional Voice Program.

In this study, two different tools developed for the parametric extraction and acoustic analysis of voice samples are compared. The main goal of the paper is to contrast the results obtained using the classical Multi Dimensional Voice Program (MDVP), with the results obtained with the novel WPCVox. The aim of this comparison was to find differences and similarities in the parameters extracted with both systems in order to make comparison of measurements and data transfer among both equipments. The study was carried out in two stages: in the first, a wide sample of healthy voices belonging to Spanish-speaking adults from both genders were used to carry out a direct comparison between the results given by MDVP and those obtained with WPCVox. In the second stage, a sample of 200 speakers (53 normal and 173 pathological) taken from a commercially available database of voice disorders were used to demonstrate the usefulness of WPCVox for the acoustic analysis and the characterization of normal and pathological voices. The results conclude that WPCVox provides very reliable measurements which are very similar to those obtained using MDVP, and very similar capabilities to discriminate among normal and pathological voices.

Linfoma T/NK laringotraqueal: caso clínico / Laryngotracheal NK/T lymphoma: clinical case

El linfoma T/NK es infrecuente, de curso agresivo y mal pronóstico. Históricamente llamado «granuloma letal de línea media», su localización habitual es el macizo centro-facial. Presentamos un caso de localización laringotraqueal, en mujer colombiana de 22 años. Refería disfonía y hemoptisis. Presentaba desestructuración y necrosis laringotraqueal. En el estudio anatomopatológico existía infiltrado polimorfo y linfoide de disposición angioinvasora y angiodestructiva. La inmunohistoquímica confirmó el fenotipo de los linfocitos T/NK: CD2, CD56 y CD3 citoplasmático positivos. Epstein-Barr positivo. TIA-1 y perforina positivas. La paciente falleció por complicaciones de la enfermedad, sin poder recibir tratamiento oncológico(AU)

NK/T-cell lymphoma is a rare condition with an aggressive course and poor prognosis. Historically known as «lethal midline granuloma», it generally appears in a midfacial location. We describe the case of a 22-year-old Colombian woman with laryngotracheal affectation, presenting with hoarseness and hemoptysis. CT scan and MRI showed severe laryngeal and tracheal destruction. The biopsy showed a polymorphic, lymphoid cell infiltrate with angiocentric and angiodestructive pattern. The immunohistochemical study confirmed the immunophenotype of the NK/T-cells: CD2+, CD56+ and cytoplasmic CD3+. The in situ hybridization and flow cytometry findings were: EBER+, TIA-1+ and perforin+. The patient died from complications of her disease, before undergoing oncologic treatment(AU)

Demanda y oferta de otorrinolaringólogos basada en la evidencia: ¿cuál es el número necesario de especialistas que se deben formar? / Demand and supply of otolaryngology specialist based on eviden What is the required number of specialists which should be trained?

Varias circunstancias concurrentes han difundido mediáticamente la presunción de falta de especialistas en España, donde existe una de las más altas densidades de médicos por población del mundo: creación simultánea de puestos de trabajo en numerosos hospitales recién construidos; aceptación de contratos basura (por meses, medias/tercios de jornadas, guardias, etc.) en hospitales relevantes antes que ocupar plazas poco atractivas; dedicación exclusiva al ámbito sanitario público o al privado en lugar de compatibilizarlos; condiciones laborales del sector público (bajos salarios, excesiva presión existencial, falta de respeto de la población y de la administración sanitaria, guardias, escasa promoción profesional, difícil agrupamiento familiar, etc.); reducción de la movilidad por impermeabilización de los mercados por la descentralización sanitaria por comunidades autónomas. En ORL no cabe hablar de déficit de especialistas, sino de desigualdades esporádicas en su distribución geográfica. Las plazas de MIR (Médico Interno Residente) ofertadas anualmente en el momento actual superan la demanda de especialistas de la sociedad española en una especialidad que se ha ido adaptando armoniosamente a los requerimientos del nuevo ejercicio de la medicina: gestión clínica, calidad asistencial, eficiencia basada en la tecnología y medicina basada en la evidencia. La modificación de las condiciones laborales mediante la flexibilización de los modelos de trabajo y la percepción de remuneraciones basadas en actividad y calidad evidenciarían que la fuerza laboral de ORL que se genera con la actual oferta puede asumir las demandas actuales y futuras. La calidad de la formación especializada en ORL es el sustrato que debe mejorarse para que los futuros especialistas de ORL sigan asumiendo los retos sanitarios sin necesidad de aumentar injustificadamente su número (AU)

Several concurrent circumstances have created an impression through the media of a presumed lack of specialists in Spain, which has one of the highest densities of doctors per population in the world: simultaneous creation of jobs in many newly built hospitals; accepting garbage contracts (for months, half/thirds of days, shifts) in relevant hospitals rather than moving to unattractive positions; full dedication to the field of public or private healthcare rather than matching them; bad public healthcare working conditions (low wages, excessive healthcare pressure, lack of respect from the public and from healthcare managers, shifts, scarce professional promotion, difficult family reunification); decreased mobility due to insulation of the markets as a result of decentralization of healthcare by regions. There is no shortage of specialists in otolaryngology, but instead there are sporadic inequalities in their geographical distribution. The current number of positions as training doctors offered annually is higher at the moment than the demand of the Spanish society, for specialists who have adapted smoothly to the requirements of the new medical practi clinical management, care quality, technology-based efficiency, evidence-based medicine. The modification of working conditions through higher flexibility in the working models and an increase of salaries based on activity and quality will show that the otolaryngology workforce which is generated with the current offer can assume the present and future demand. A high quality of specialized otolaryngology training is the substrate to be improved, so that future otolaryngology specialists will be able to face health challenges without unduly increasing their number (AU)

Miringoplastias primarias. Resultados a los 2 años de seguimiento / Primary myringoplasties. Results after a 2 year follow-up period

Introducción y objetivos: La miringoplastia tiene como finalidad el cierre de la perforación timpánica y mejorar la audición, con resultados variables en la literatura. Nuestro objetivo fue saber cuál es la realidad de esta cirugía en nuestro centro y compararla con la publicada. Métodos: Análisis retrospectivo de 217 miringoplastias primarias efectuadas en el Servicio de Otorrinolaringología del Hospital Universitario Ramón y Cajal entre los años 1998 y 2003, con descripción de las características de perforación, técnica quirúrgica y resultados postoperatorios (cierre de la perforación y mejoría de la audición). Resultados: En su mayoría eran adultos y la etiología principal fue la secuela otorreica (91 %). Predominaron perforaciones menores a subtotal en tamaño (64 %) que no afectaban al anillo timpánico (79 %). La técnica de colocación del injerto respecto al resto timpánico fue lateral (45 %), mixta (29 %) y medial (26 %); se utilizó el abordaje retroauricular (66 %) y endoaural (34 %). La fascia de músculo temporal fue el injerto más utilizado (87 %). El cierre de la perforación se consiguió entre un 78 y un 91 % de los casos a lo largo de los 24 meses de seguimiento, con un valor final del 78 % a los 2 años de seguimiento. La mejora de la audición, reflejada como un umbral diferencial audiométrico menor de 20dB, se observó en aproximadamente el 56 % de los casos. Conclusiones: La miringoplastia en nuestro centro alcanza cifras de éxito anatómico (78 %) y funcional (56 %) comparables con las de la literatura. Consideramos fundamental el seguimiento a medio plazo de los pacientes por el fenómeno de reperforación, que puede ocurrir hasta pasados 2 años o más (AU)

Introduction and goals: The goals of myringoplasty are closure of the perforation in the tympanic membrane and improvement in hearing levels, with varying results in the published literature. Our aim was to determine the results of this procedure at our centre and compare them with the literature. Methods: Retrospective analysis of 217 primary myringoplasties carried out in the Otorhinolaryngology Department of the Ramón y Cajal University Hospital between 1998 and 2003, describing the characteristics of the perforations, surgical technique and post-operative results (perforation closure and hearing improvement). Results: The majority were adults with perforations secondary to recurrent middle ear infections (91 %). Most were less than sub-total (64 %) and did not involve the tympanic annulus (79 %). Grafts were inserted using lateral (45 %), mixed (29 %) and medial (26 %) techniques, using retroauricular (66 %) and endaural (34 %) approaches. Temporal muscle fascia was the graft most frequently used (87 %). Perforation closure was achieved in between 78 % and 91 % of cases throughout the 24-month follow-up period, with an overall closure value of 78 % after 2years of follow-up. Hearing improvement, established as an air bone gap difference of less than 20dB, was seen in proximately 56 % of cases. Conclusions: At our centre, myringoplasty achieves anatomical (78 %) and functional (56 %) success comparable to the results described in the literature. We consider medium-term follow-up to be of the utmost importance because of reperforation phenomena, which may occur as much as 2 years or more after surgery (AU)