SLEEP-GOAL: A multicenter success criteria outcome study on 302 obstructive sleep apnoea (OSA) patients.

OBJECTIVE: To demonstrate SLEEP-GOAL as a more holistic and comprehensive success criterion for Obstructive Sleep Apnoea (OSA) treatment. METHODS: A prospective 7-country clinical trial of 302 OSA patients, who met the selection criteria, and underwent nose, palate and/or tongue surgery. Pre- and post-operative data were recorded and analysed based on both the Sher criteria (apnoea hypopnea index, AHI reduction 50% and <20) and the SLEEP-GOAL. RESULTS: There were 229 males and 73 females, mean age of 42.4±17.3 years, mean BMI 27.9±4.2. The mean VAS score improved from 7.7±1.4 to 2.5±1.7 (p<0.05), mean Epworth score (ESS) improved from 12.2±4.6 to 4.9±2.8 (p<0.05), mean body mass index (BMI) decreased from 27.9±4.2 to 26.1±3.7 (p>0.05), gross weight decreased from 81.9±14.3kg to 76.6±13.3kg. The mean AHI decreased 33.4±18.9 to 14.6±11.0 (p<0.05), mean lowest oxygen saturation (LSAT) improved 79.4±9.2% to 86.9±5.9% (p<0.05), and mean duration of oxygen <90% decreased from 32.6±8.9 minutes to 7.3±2.1 minutes (p<0.05). The overall success rate (302 patients) based on the Sher criteria was 66.2%. Crosstabulation of respective major/minor criteria fulfilment, based on fulfilment of two major and two minor or better, the success rate (based on SLEEP-GOAL) was 69.8%. Based solely on the Sher criteria, 63 patients who had significant blood pressure reduction, 29 patients who had BMI reduction and 66 patients who had clinically significant decrease in duration of oxygen <90% would have been misclassified as "failures". CONCLUSION: AHI as a single parameter is unreliable. Assessing true success outcomes of OSA treatment, requires comprehensive and holistic parameters, reflecting true end-organ injury/function; the SLEEP-GOAL meets these requirements.

[VOTE versus ACLTE: comparison of two snoring noise classifications using machine learning methods]. / VOTE versus ACLTE: Vergleich zweier Schnarchgeräuschklassifikationen mit Methoden des maschinellen Lernens.

BACKGROUND: Acoustic snoring sound analysis is a noninvasive method for diagnosis of the mechanical mechanisms causing snoring that can be performed during natural sleep. The objective of this work is development and evaluation of classification schemes for snoring sounds that can provide meaningful diagnostic support. MATERIALS AND METHODS: Based on two annotated snoring noise databases with different classifications (s-VOTE with four classes versus ACLTE with five classes), identically structured machine classification systems were trained. The feature extractor openSMILE was used in combination with a linear support vector machine for classification. RESULTS: With an unweighted average recall (UAR) of 55.4% for the s­VOTE model and 49.1% for the ACLTE, the results are at a similar level. In both models, the best differentiation is achieved for epiglottic snoring, while velar and oropharyngeal snoring are more often confused. CONCLUSION: Automated acoustic methods can help diagnose sleep-disordered breathing. A reason for the restricted recognition performance is the limited size of the training datasets.

[Sentinel lymph node in tumors of the larynx: technique and results]. / El ganglio centinela en tumores de laringe: técnica y resultados obtenidos.

OBJECTIVES: To evaluate the applicability of sentinel node biopsy in NO carcinomas of the larynx. MATERIALS AND METHODS: We carried out a prospective study in 19 patients with carcinoma of the larynx NO. We peritumorally infiltrate with 1 mCi 99mTc-labeled nanocolloidal albumin via rigid endoscopy in general anaesthesia. Sentinel node detection is performed with a gamma sonda during lymph node detection. The histological results of the sentinel node are compared with the excised neck dissection specimen. RESULTS: Identification of sentinel node was successful in 17 patients (89.47%). In 11 patients the sentinel node was tumor negative reflecting the correct neck lymph node status (pNO). Three patients had metastases in the sentinel node. We observed three false- negative. The sensitivity of the technique was 50% (3/6) and the negative predictive value 78.6%. CONCLUSIONS: We think that more studies are needed to use the technique in the laryngeal cancer and that a correct selection of the patients is essential.

[Clinical evaluation of the patient with a chronic snoring disease]. / Evaluación clínica del paciente con roncopatía.

INTRODUCTION: Sleep disordered breathing patients usually undergo an ENT clinical examination before any therapeutic decision is taker. This clinical examination should be predictive about the occurrence of OSAS, reproductible and should determine the sites of obstruction in the upper airways. We have evaluated the clinical ENT examination and compared it with the bibliography in order to standardize it. MATERIALS AND METHODS: We have done the same clinical ENT examination to 181 patients. 127 had a standar polysomnography. RESULTS: The patient's mean age was 49.6 years, the mean BMI was 29.3 kg/m2. 92.7% had an abnormal palate, 4.5% a tonsilar hipertrophy, 66.5% high Modified Mallampati scores, 60.8% were clasiffied as Fujita IIb type and 39.2% had nasal obstruction. CONCLUSIONS: Upper airway examination is important for the assessment of chronic snoring patients. Most of them have anatomical alterations that can be represented in visual scales to make it more reproductible. The obstruction area does not predict the severity of OSAS.

[Our findings in the sleep endoscopy exams]. / Nuestros hallazgos en la videofibrosomnoscopia.

INTRODUCTION: Sleep endoscopy is a technique that allows a direct visualization of the pharynx during drug-induced sleep. It allows an assessment of the anatomical site of obstruction or vibration in habitual snorers. MATERIALS AND METHODS: A total of 51 patients underwent sleep endoscopy. All answered a standard questionnaire and underwent an otolaryngological exam as a part of the diagnostic procedure. RESULTS: The most frequent site of obstruction was the palate in 90.4%, followed by the base of the tongue in 38.5%. Obstruction at multiple levels was found in 60.7% of patients. No correlations were found between the level of the obstruction found in the ENT examination and the one found during the sleep endoscopy. CONCLUSIONS: Sleep endoscopy is useful for the assessment of the usual snorer and we recomend it to label the patient's obstruction.

[Temporalis myofascial flap: technique description and results in our patients]. / Colgajo miofascial del músculo temporal: descripción de la técnica y resultados en nuestros pacientes.

INTRODUCTION: Surgical treatment of intraoral and maxillary sinus carcinomas requires a reconstructution of the defect. It is better to do it in one time in order to decrease the morbidity for the patient and the sanitary cost. The temporalis myofascial flap is used for reconstruction of oral cavity, skull base, periorbital region and maxilla because of its feasibility. MATERIAL AND METHODS: We describe the surgical technique and present our results of the reconstructions after total or partial maxillectomy using the temporalis muscle flap in 22 patients. RESULTS: No total necrosis of the flap was seen in any case, a partial necrosis was seen in four cases. CONCLUSION: The temporalis myofascial flap is an excellent choice for oral and maxillary reconstruction.

[Malignant tumors of the parotid gland]. / Tumores malignos de la glándula parótida.

We review patients operated of parotidectomy in our ENT department of Dr. Peset Hospital from Valencia during the period 1975-2001. We sheltered an amount of 147 cases. The pathologic distribution between benign and malign tumors was as following: 121 benign tumors (83%) and 26 malign tumors (17%). Here we study malign parotid tumors, which represent 17% of total parotid tumors. Sensibility and specificity of FNA was 54% and 96.5% respectively. We performed almost with similar frequencies total and suprafacial parotidectomies in 46% and 42% of cases respectively. Total parotidectomy with facial resection is indicated in cases with tumor nerve infiltration and has been done in 8% of cases. The main complications of surgery were facial nerve dysfunction and Frey syndrome. Permanent facial nerve dysfunction and and transitory facial nerve disfunction occurred in 3.8% and 30.8% of patients respectively. Frey syndrome appeared in 10% of patients operated of parotidectomy. Recurrences occurred in 15.4% of patients.

[Benign thyroid disease and cancer in our environment]. / Enfermedad tiroidea benigna y cáncer en nuestro medio.

We compile our experience about the association between benign thyroid disease and thyroid carcinoma, and perform a review on the literature about this theme. We conclude on the importance of knowing this association, even not statistically significative, when it is detected modifies totally our therapeutic attitude and the vigilance of these patients.

[Carcinoma of the thyroid gland. Correlation between diagnostic tests and pathogenic anatomy]. / Carcinoma tiroideo. Correlación entre las pruebas diagnósticas y la anatomía patológica.

We present the results of a retrospective study about 101 cases of thyroid carcinoma treated in our ENT-department during the period 1979-1998. We consider the epidemiologic, diagnostic and therapeutic aspects. Epidemiologically 82% of patients were female and 18% male, with a mean age of 51 year. About 12 percent of patients had familiar antecedents of thyroid pathology. The thyroid pathology affected preferently the right thyroid lobe in 40 percent of cases, the left lobe in 28.9 percent, the isthmus in the 6.7 percent and in 24.4 percent it was bilateral. Hormonal 93.8 percent were in euthyroid state and the 6.2 percent of the whole were tested and show hyperparathyroidism. Complementary examinations showed, in gammagraphy, a cold solitary nodule in 48 percent of patients. The echography more frequently discovered a solitary nodule in 36.7 percent or multiple solid nodules in 34.7 percent. Fine needle biopsy sensitivity was in 85.7 percent. Histologic types encountered were: papillary carcinoma (74.26), follicular carcinoma (14.85), Hürthle cells carcinoma (3.96), medullary carcinoma (3.96) and anaplastic carcinoma (2.97 percent). Choice treatment of thyroid carcinoma, in our Department, was total thyroidectomy.

[Treatment and development of thyroid carcinoma]. / Tratamiento y evolución del carcinoma tiroideo.

Reporting the results of a retrospective study on 101 cases of carcinoma of the thyroid gland, treated in our Service between 1979 and 1998. Analysis of the several anatomopathological variables found, the surgical treatment and also with radioactive isotopes, the complications and the condition evolution. Epidemiologically 82 percent of patients were women and men the 18 percent. Middle age 51 years. 12 percent of patients had familiar antecedents of thyroid pathology. The histological types found were: papillary carcinoma (74.26%), follicular carcinoma (14.85%), Hürthle's cellules carcinoma (3.96%) and anaplastic carcinoma (2.97%). In our Service elective treatment of thyroid gland carcinoma is total thyroidectomy with neck dissection in 18.3 percent of affected. The survival rate amount for 81.3 percent at five years. The aim of this article is to display the therapeutics and evolution of thyroid gland cancer, based in our own 18 years of experience acquired in the Service.

[Benign surgical thyroid pathology in our milieu. Correlation between exploratory tests and anatomopathology]. / Patología quirúrgica tiroidea benigna en nuestro medio. Correlación entre las pruebas exploratorias y la anatomía patológica.

In our milieu, Dr. Peset Hospital, Valencia, we have collected between 1979 and 1998, a total amount of 683 thyroidectomies. Between them 101 carcinomata and 582 bening thyroid pathology. In this work are studied the bening pathology treated surgically. 86.4 percent were women and 13.6% men. Middle age 45 years. By complementary explorations, echography the solid single node by 41.9 percent of cases and solid numerous nodes by 34.7% were the more important findings found. By gammagraphy with greater frequency discovered a cold single node by 44.2% of cases. Anatomopathological types more frequently found were single hyperplastic node (13.3%), multiple hyperplastic nodes (27.6%), spreading hyperplasy (9.1%) and follicular adenoma (37.4%). The aim of this work is the comparative study of findings of complementary explorations with the anatomopathological results gained through the surgical pieces.

[Unilateral polyposis: evaluation of preoperative tests]. / Poliposis unilaterales: evaluación de las pruebas preoperatorias.

UNLABELLED: The aim of this paper is to study a group of patients with occupancy of a nasal fossal, apparently by polyps, and being the other side of the nose normal. Evaluating on the one hand the true incidence of unspecific polyposis and, of other diagnosis, and on the other hand to compare the preoperative radiological findings with those seen during surgery. MATERIAL AND METHODS: A prospective study of 23 consecutive patients was carried out over a period of 30 months at the ENT Department of the Dr. Peset Hospital, in Valencia. A CT scan and preoperative biopsy was performed in all cases, the results of these being later compared with the surgical findings and the final histopathologic diagnosis. RESULTS AND CONCLUSIONS: A discrepancy between the preoperative biopsy and final diagnosis was found in 26% of the patients. The incidence of polyposis was 52%, inverted papilloma 26%, malignant tumours 13% and other diagnosis 8.6%. There is a good correlation between preoperative CT scans and surgical findings in those cases of polyposis and inverted papilloma, but not in those of malignant tumours as CT scans often underestimated these lesions.

[Tympanoplasty using cartilage: 3 years of experience]. / Timpanoplastia con cartílago: 3 años de experiencia.

We present our results in a timpanoplasty technique using autologous cartilage, in a retrospective study of 71 cases within 3 years. We used this technique in revision surgery, large perforations, severe retractions, and atrophic membranes. 32% of cases needed ossicular chain reconstruction. A complete closing of the membrane was obtained in 86% of cases, while 14% remained re-perforated or discontinued between cartilage pieces. These results are comparable to other studies using cartilage graft with several techniques. These results encourage us to continue using this technique in order to acquire more experience and a better knowledge about the efficacy of this technique.

[Video fiber endoscopy during induced sleep]. / Videofibrosomnoscopia.

Video-fiberoscopy is the exploration of upper respiratory airways used in our diagnostic protocol in patients with chronic snoring and obstructive sleep apnea syndrome (OSAS). We perform a fibroscopy during propofol induced sleep without tracheal intubation; video recording and monitoring of level of sleep, pulse oximetry, blood pressure, ECG, etc. is used. This exploration allows us to asses upper respiratory airways when the patient is asleep as well as the areas of collepse and vibration both from a functional and anatomical points of view.

[Spontaneous middle ear meningoencephalic herniation. 2 case reports]. / Herniación meningoencefálica espontánea en oído medio: a propósito de dos casos.

Two cases of idiopathic brain herniation into the middle ear without previous surgery are reported. Brain herniation is an unusual pathology, usually related to middle ear surgery. The idiopathic appearance of this disease is the secondly most frequent cause. Its origin is believed to be related to a congenital defect of tegmen timpani. Two elements, both rare, are emphazised: the spontaneous bilateral presentation in one of the cases, and the CSF leak as an initial symptom. We present a review of the literature, describing epidemiology results and the main accepted etiology theories. We discuss the diagnosis and treatment methods: magnetic resonance imaging and surgery.

[Why does a mastoidectomy cavity become suppurative? Our experience and revision of the literature]. / Por qué supura una cavidad de mastoidectomía? Nuestra experiencia y revisión de la literatura.

The main goal for performing surgery for chronic otitis media is to eliminate the disease and improve hearing whenever possible. Persistent drainage of a mastoid cavity means failure of surgery and of achieving the goal. In this study, we present our department's attitude for suppurative mastoid cavities as well as the reasons that do not allow adequate control of them.

[Treatment of the NO neck in supraglottic cancer]. / Tratamiento del cuello NO en el cáncer supraglótico.

INTRODUCTION: Occult regional metastases in supraglottic cancer NO are the object of classical controversies. The aim of our study is to provide our experience in order to determine how neck treatment affects on regional recurrence of NO supraglottic cancer. METHODS: A retrospective study of 246 patients with NO supraglottic cancer treated in our service between 1977 to 1999 is presented. RESULTS: 11.4% of patients did not have any cervical treatment, with a 23% of neck recurrence amongst the evolution. 66.7% of patients were treated with a modified radical neck dissection, 24% of these presented occult metastases in the histopathological study. Global regional recurrence was 2.9% in early stages (T1/T2) and 13.1% in advanced stages (T3/T4). In pN+ patients, 85% underwent postoperative radiotherapy, with a regional recurrence of 8.8%. Postoperative clinical control without any other treatment in pN0 patients showed a neck recurrence of 6.1%. We performed a unilateral neck dissection in those patients with clear-lateral tumours. In these cases the clinical control of the contralateral neck gave a 5.5% recurrencies on that side. Patients treated with elective primary radiotherapy suffered a 5.5% of regional recurrence. DISCUSSION/CONCLUSIONS: Neck treatment of the NO supraglottic cancer is recommended. We treat neck in the same way of primary tumour (surgery or radiotherapy) with good control of regional recurrencies, less than 10%. In case of a negative pathological study of the neck careful, watching is the elective attitude. In the positive pathological study of the neck (pN+), radiotherapy is the elective treatment in those with three or more affected nodes or capsular breakdown in any of them.

[Hypopharyngeal cancer: analysis of the evolution and surgical results]. / Cáncer de hipofaringe. Análisis de la evolución y resultados del tratamiento quirúrgico.

OBJECTIVE: Hypopharyngeal carcinoma is an aggressive malignancy that usually presents at a late stage, thereby resulting in an overall poor prognosis for these patients. The aim of this study is to determine the evolution and postoperative results of patients treated in our department for hypopharyngeal cancer. METHODS: We retrospectively reviewed 60 patients who had undergone surgery followed by radiation therapy between 1980-1999. Most of them were advanced stage (III-IV) and 75% patients showed regional metastases at presentation. RESULTS: The 5-year survival rate was 38.4%. The overall incidence of distant metastases and second neoplasms was 12.5% and 10.4%. CONCLUSIONS: Hypopharyngeal cancer remains one of the most lethal ones in head and neck cancer. The poor survival rate is related primary to advanced stage disease and particularly to lymph node metastases.

[Changes in immunoglobulin levels following adenoidectomy and tonsillectomy]. / Alteraciones de la inmunidad tras adenoidectomía y amigdalectomía.

INTRODUCTION: Lymphoid tissue from Waldeyer's ring produces all types of immunoglobulins, mainly G and A, and between 4 to 10 years, of age. In other words, the age in which the adenoid and tonsillar surgery is carried out. Our study tries to analyze the impact of the tonsillar surgery on the serum levels of immunoglobulins. MATERIAL AND METHODS: We present a prospective study with 89 healthy children aged between 4 to 10 years. Immunoglobulin G, A and M levels were measured preoperatively, at a month and at four months after adenoidectomy and/or tonsillectomy. RESULTS: Serum IgG levels dropped after surgery, but partially recovered four months later. IgA dropped less significantly and IgM did not change its levels. No one of the studied inmunoglobulins dropped below the normal serum levels. DISCUSSION/CONCLUSIONS: Adenoid and tonsilar surgery cause a fall of postoperative immunoglobulin G and A serum levels, partially recovering after four months. Serum levels never dropped below normal levels, and of the studied children suffered a postoperative disease due to immunodeficiency.

Surgical voice restoration after total laryngectomy: long-term results.

Tracheoesophageal puncture (TEP) with a voice prosthesis has been the preferred treatment for speech rehabilitation of total laryngectomies at the Dr. Peset Hospital since 1984. This study reviews 350 consecutive patients over a 15-year period. There were 334 patients with primary and 16 with secondary TEP. Long-term tracheoesophageal speech was achieved in approximately 70% of our patients. Problems related to or affecting TEP for voice restoration were studied. The different types of problems identified occurred in proportions ranging from 0.6% to 18%. Most of them were easily managed, but problems such as salivary leakage and dislodging of the prosthesis led to tracheoesophageal tract closure in 30% of the patients.