Healthcare aspects of peritonsillar infection before and during the COVID-19 pandemic.

INTRODUCTION: This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI). MATERIALS AND METHODS: In a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded. RESULTS: From 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases. CONCLUSIONS: The protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis.

[Healthcare aspects of peritonsillar infection before and during the COVID-19 pandemic]. / Aspectos asistenciales de la infección periamigdalina antes y durante la pandemia de COVID-19.

Introduction: This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI). Materials and methods: In a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded. Results: From 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24 h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases. Conclusions: The protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis.

Blood Viscosity in COVID-19 Patients With Sudden Deafness.

BACKGROUND: Changes in blood viscoelastic properties have been proposed previosuly as etiopathogenesis for severe complications in COVID-19 and some cases of Sudden Deafness (SD). This is an attempt to verify if SD cases in patients admitted for SARS-Cov-2 infection can be correlated. PATIENTS AND METHODS: A prospective follow-up was carried out with COVID-19 patients, monitoring their blood viscosity (BV) at high shear rate (300 s-1) and inquiring them periodically for eventual hearing loss. This measurement was extended to cases bearing of SD in 2019 and 2020 without infection and a control group of healthy normoacoustic subjects. RESULTS: The normality range was 4,16 ± 0,62 cps. 330 cases admitted for COVID-19 were evaluated from February 24th, 2020 to March 24th, 2021, 85 of them attended in ICU. After anamnesis and Audiometric Tone Thresholds developed as soon as possible, 9 SD were detected, all belonging to ICU group. The mean BV was 4,38 ± 0,43 cps in the ward group, 4,53 ± 0,39 cps in the ICU patients without SD, and 4,85 ± 0,52 cps in the cases with SD, with statistically significant differences. Highest BV elevations in the SD cases were detected between days 6 and 10 of hospital admission. In 2019 four cases consulted with SD, and another two did it in 2020 without a diagnosis of COVID-19, with normal BV values. CONCLUSIONS: During SARS-Cov-2 infection, patients may show high BV and SS, although an inpatients control group and a larger sample volume are necessary to confirm the predisposition to hyperviscosity. The incidence of hearing damage is considerable if its possible appearance is taken into account, within the limitations of critical patients with COVID-19.

Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience.

INTRODUCTION: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. PATIENTS AND METHODS: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. RESULTS: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7 ±â€¯11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. CONCLUSIONS: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.

[Blood viscosity in COVID-19 patients with sudden deafness]. / Viscosidad sanguínea en pacientes COVID-19 con sordera súbita.

Background: Changes in blood viscoelastic properties have been proposed previosuly as etiopathogenesis for severe complications in COVID-19 and some cases of Sudden Deafness (SD). This is an attempt to verify if SD cases in patients admitted for SARS-CoV-2 infection can be correlated. Patients and methods: A prospective follow-up was carried out with COVID-19 patients, monitoring their blood viscosity (BV) at high shear rate (300 sec-1) and inquiring them periodically for eventual hearing loss. This measurement was extended to cases bearing of SD in 2019 and 2020 without infection and a control group of healthy normoacoustic subjects. Results: The normality range was 4,16±0,62 cps. 330 cases admitted for COVID-19 were evaluated from February 24th, 2020 to March 24th, 2021, 85 of them attended in ICU. After anamnesis and Audiometric Tone Thresholds developed as soon as possible, 9 SD were detected, all belonging to ICU group. The mean BV was 4,38±0,43 cps in the ward group, 4,53±0,39 cps in the ICU patients without SD, and 4,85±0,52 cps in the cases with SD, with statistically significant differences. Highest BV elevations in the SD cases were detected between days 6 and 10 of hospital admission. In 2019 four cases consulted with SD, and another two did it in 2020 without a diagnosis of COVID-19, with normal BV values. Conclusions: During SARS-CoV-2 infection, patients may show high BV and SS, although an inpatients control group and a larger sample volume are necessary to confirm the predisposition to hyperviscosity. The incidence of hearing damage is considerable if its possible appearance is taken into account, within the limitations of critical patients with COVID-19.

Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience. / Factores implicados en el éxito y fracaso de la dacriocistorrinostomía endoscópica desde nuestra experiencia.

INTRODUCTION: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. PATIENTS AND METHODS: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. RESULTS: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7 ± 11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. CONCLUSIONS: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.

ENT involvement in Leishmania infections. / Implicación ORL en infecciones por Leishmania.

INTRODUCTION: Leishmaniasis comprises a group of diseases caused by protozoan parasites of the genus Leishmania that are transmitted by the bite of infected phlebotomine mosquitoes from animal reservoirs. Three different clinical forms are generated: cutaneous, mucocutaneous and visceral. We present the findings in the head and neck of this disease observed in our health area. PATIENTS AND METHODS: A review of the last 26 years in our hospital, noting the clinical, diagnostic and therapeutic characteristics of the cases detected. RESULTS: Thirteen cases were identified, 7 cutaneous, 4 mucocutaneous and 2 visceral or kala-azar. The mean age was 53.7±10.8 years. Immunodeficiency was identified in 61% of the cases. The incidence of the disease was 1.5:100,000 inhabitants/year, with a prevalence of 2%. Of those infected, 69% had involvement of the ear-nose-throat area. In 12 cases the diagnosis was established by biopsy of the lesions. The time from clinical debut to diagnosis ranged from 3 to 10 months. Antimony compounds were used as treatment in 11 patients and amphotericin B in 3, alone or combined with the former. One cutaneous form resolved with excision of the lesion. Ninety-two percent healed clinically and parasitologically. CONCLUSIONS: Leishmaniasis in Spain frequently entails cutaneous and mucocutaneous involvement, often of the skin of the head, face and neck or upper-airway mucosa. Its clinical presentation varies greatly, and it should be suspected if there is no response to conventional therapies and in conditions of immunodeficiency.

"The importance of preoperative evaluations prior to pediatric otorhinolaryngological surgery".

OBJECTIVE: To describe the results of preoperative evaluations prior to pediatric surgery. MATERIALS AND METHODS: We reviewed a total of 99 patients, with mean age of 6.53 + 2.39 years, an average of 11.04 months after their inclusion on the surgical treatment list. These patients were obtained from General University Hospital of Valencia surgery waiting list between October 2015 and July 2016. We have reassessed all the patients before their surgery date and analyzed the results: the indication had changed or not. In the case of indication changed, the outcome was subdivided into: extension, reduction, or surgery no indicated because a clinical resolution. RESULTS: After waiting on the list for surgery for an average of 11 months, the initial surgical indication had changed in 52 patients (52%), this groups was subdivided into: 33 patients (33%) had spontaneously resolved by the time of their reassessment and their clinical symptoms no longer met the criteria for surgery, the indication for surgery was extended in 10 patients (10%) and was reduced another 9 patients (9%). We found a statistically significantrelationship (p = 0.034) between the age of the patients at the time of the preoperative re- evaluation and modifications made to the initial surgery indication. CONCLUSIONS: Our results show the dynamic evolution of benign Waldeyer-ring related pathologies in the pediatric population due to physical growth and immune development. The clinical evaluation prior to benign pediatric surgery is recommended In specially in the group over 5 years.

Incidence of diffuse idiopathic skeletal hyperostosis from a model of dysphagia. / Incidencia de la hiperostosis esquelética difusa idiopática sobre un modelo clínico de disfagia.

OBJECTIVE: To relate symptoms of dysphagia to Forestier-Rotes Querol disease or diffuse idiopathic skeletal hyperostosis (DISH), a disorder due to ossification in the anterior longitudinal ligament and calcifications in other entheses. PATIENTS AND METHODS: Review of clinical and radiological findings in 455 outpatients attended at our Centre with dysphagia, for 5years, referred from dental, trauma, neurological or primary health care. A diagnosis of DISH was established using Resnick's criteria. RESULTS: We detected 51 cases with dysphagia consistent with DISH diagnostic criteria - 11.2% of subjects suffering this symptom- out of 32544 outpatients attended. An incidence of 7:100000 inhabitants per year was observed. Two cases showed significant improvement after removing the new bone in the spine. CONCLUSIONS: DISH is an ankylosing ossification between the joints, frequently systemic but showing no clinical symptoms. When symptoms manifest, neck movements and upper airways are involved, mainly dysphagia. A few cases need surgery to relieve the calcification processes.

Transoral (transvestibular-paramandibular) endoscopic approach for benign tumours in the infratemporal fossa.

We describe a minimally invasive transoral approach to the infratemporal fossa, by means of endoscopy, which facilitates examination and resection of lesions in this area. Furthermore, we outline the technique employed and a case treated with this approach, which permits a rapid access with very low patient morbidity, due to the use of endoscopy and of transoral access, instead of traditional transfacial approaches.

Audiologic and subjective evaluation of Baha® Attract device. / Valoración audiológica y subjetiva del dispositivo Baha® Attract.

We included 9 patients implanted with Baha® Attract. All our patients were evaluated by free field tonal audiometry, free field verbal audiometry and free field verbal audiometry with background noise, all the tests were performed with and without the device. To evaluate the subjective component of the implantation, we used the Glasgow Benefit Inventory (GBI) and Abbreviated Profile of Hearing Aid Benefit (APHAB). The auditive assessment with the device showed average auditive thresholds of 35.8dB with improvements of 25.8dB over the previous situation. Speech reception thresholds were 37dB with Baha® Attract, showing improvements of 23dB. Maximum discrimination thresholds showed an average gain of 60dB with the device. Baha® Attract achieves auditive improvements in patients for whom it is correctly indicated, with a consequent positive subjective evaluation. This study shows the attenuation effect in transcutaneous transmission, that prevents the device achieving greater improvements.

Hiccups. Attitude in Otorhinolaryngology Towards Consulting Patients. A Diagnostic and Therapeutic Approach. / Hipo. Actitud en otorrinolaringología en pacientes que consultan. Aproximación diagnóstica y terapéutica.

INTRODUCTION: Hiccup crises are generally benign and self-limiting, but longer episodes affect quality of life and must be treated. There are recognisable causes that otorhinolaryngologists must know and be aware for diagnosis and therapeutic alternatives. The main expression is a spasmodic glottic noise with characteristic neck alterations. PATIENTS AND METHODS: This was a retrospective study from 1979 with patients suffering persistent or recurrent hiccups. Chronobiology, comorbidity, findings from explorations, therapies and outcomes were noted. Thirty-seven patients were studied (mean age, 45.5±13.5 years; 30 males), with persistent hiccups in 23 (62%). RESULTS: A potential associated aetiology was observed in 24 cases (65%): oesophageal disorders -mainly gastroesophageal reflux- were detected in 14 cases and concomitant oncological disease was found in 8. Only 3 cases were admitted for surgery due to these findings. Therapeutic strategies with metoclopramide were used in 18 subjects, chlorpromazine in 17 and baclofen in 13, while carbamazepine or haloperidol were used in a minority. Phrenic nerve stimulation was employed in 6 patients. Hiccups disappeared in 32 cases. Out of 22 cases for which follow-up was possible, the hiccups recurred in 5 subjects (the subjects requiring new therapies) and 11 patients died. CONCLUSIONS: Chronic hiccup represents a multidisciplinary challenge that includes potential head and neck affection, a diagnostic schedule for ruling out causes, frequent base oesophageal alterations and high incidence of malignant neoplasm. Prokinetic and neuroleptic agents with antidopaminergic and anticholinergic effects are the pillars of its treatment.

Factors related to post-tonsillectomy pain in adults.

OBJECTIVE: Assessment of factors related to pharyngeal anatomy and surgical technique as possible causes of post-tonsillectomy pain. MATERIALS AND METHODS: This was a prospective observational study that included 42 patients undergoing tonsillectomy with cold and monopolar electric device dissection. We recorded duration of the entire operation, duration of electrocautery use, tonsil size and postoperative pain and discomfort assessed using a visual analogue scale (VS) and a 40-item questionnaire (QoR-40, Quality of Recovery), along with sequelae on returning to normal diet, weight loss and hospital stay. Correlations among quantitative variables were obtained by mean of lineal regression coefficients. RESULTS: Duration of surgery was 22.66 ± 7.07 minutes, removing tonsils with a volume of 6046.07 ± 3866.20 mm(3) and an electrocautery use time of 66.14 ± 37.77 seconds, applying 1984.24 ± 1133.32 joules per patient. The most frequently observed Mallampati classification and tonsil size scores were stages II and III. The VS score increased and QoR-40 decreased at 24 hours and 7 days, but differences were statistically non-significant. Joule amount used for electrocautery was the parameter that correlated the best with discomfort status as measured via assessment scores, analgesic and corticosteroid requirements, weight loss and hospital stay. Pain was higher in subjects submitted to peritonsillar surgical aggression. CONCLUSIONS: Improved use of electrodissection techniques, limiting and focusing the application of its energy, and preservation of peritonsillar mucosa are factors that may lower post-tonsillectomy pain levels.

Relationship between video head impulse test (vHIT) and caloric test in patients with vestibular neuritis. / Relación entre el video head impulse test (vHIT) y la prueba calórica en el estudio evolutivo de pacientes con neuritis vestibular.

INTRODUCTION AND OBJECTIVES: The caloric test is the gold standard for the loss of vestibular function diagnosis. The Video Head Impulse Test (vHIT) assesses the same reflex by using a video- assisted examination of the impulsive maneuver. We intend to compare the variation of results of the vHIT and the caloric test in patients with vestibular neuritis with respect to their initial condition at two different moments of their evolution and to check the level of correlation between them and with that of the DHI test METHODS: We explored 20 patients with neuritis by using both vHIT and the caloric test on the same day. We assessed the correlation between these two tests and with the DHI test for each patient at two different moments of their evolution. RESULTS: We calculated gain asymmetry and compared it with the canal paresis, but we found neither a linear correlation between them, nor a correlation between the DHI test or improvement of these two other tests. We conclude that the covert saccades maintain a similar speed whilst present in the VHIT, but the overts diminish their speed over time. CONCLUSIONS: The VHIT and the caloric test show different responses of the vestibulo-ocular reflex, because they stimulate different frequencies of this reflex. No correlation was found between the VHIT, the caloric test and the DHI test. The tests appear to complement one another.

Epistaxis and dabigatran, a new non-vitamin K antagonist oral anticoagulant.

OBJECTIVE: Dabigatran is a new non-vitamin K antagonist (VKA) anticoagulant with anti-thrombin action, with supposedly fewer haemorrhagic complications. However, there are actually no established agents to reverse its effect, nor specific coagulation time tests for monitoring it. MATERIALS AND METHODS: An observational prospective study was developed, noting epidemiological, clinical and therapeutic features among subjects with epistaxis treated with dabigatran. Results were compared with a group of epistaxis cases of individuals under anticoagulant therapy with VKA (acenocoumarol) and a control group without anticoagulation. RESULTS: Since its inclusion in our health system almost 3 years ago, 19 patients with epistaxis and concomitant use of dabigatran have been attended at the Emergency Unit in our hospital, as against 59 under VKA therapy and 144 without anticoagulation, with a mean admittance rate of 26%, 28% and 14%, respectively. In 3 out of 5 individuals admitted due to dabigatran treatment, previously unobserved renal failure was detected. Blood transfusion was needed in 80% of patients using dabigatran, 58% using VKA and 23% without anticoagulation. Invasive procedures to control nosebleed were required in 80%, 35% and 21%, respectively. Although haemorrhagic risk was lower in dabigatran cases, they showed the longest stay in the hospital when compared to the other groups. CONCLUSIONS: With dabigatran, there are fewer cases of severe epistaxis than with acenocoumarol, but controlling them is more difficult.