Perceptions and Management of Allergic Rhinitis Among Ecuadorian Otorhinolaryngologists: A Survey-Based Study.

OBJECTIVE: Allergic rhinitis (AR) represents a large burden to the healthcare system due to its high prevalence and impact on patients' lives. Despite the existence of evidence-based guidelines, some studies have found that physicians do not always follow the latest recommendations. The aim of our study was to determine how Ecuadorian otorhinolaryngologists (ENTs) perceive some epidemiological aspects related to AR, as well as their preferences for managing the disease. METHODS: We conducted an observational, survey-based cross-sectional study, among 116 Ecuadorian ENTs. The survey used was adapted from a previous publication and consisted of 30 multiple choice questions, concerning several topics of AR. Descriptive statistics (frequency, and standard deviation) were performed for clinical and demographic variables. RESULTS: A total of 116 Ecuadorian ENTs completed the survey. Of them, 62.9% were male, with an average age of 42 years (SD ± 11.58). Computed tomography (CT) scan and nasal cytology were selected as the main diagnostic tests for AR by 62/91 (68.1%) and 45/91 (49.5%) of participants, respectively. Moreover, only 12/116 (10.3%) of participants performed skin prick tests (SPT). Allergen immunotherapy (AIT) was performed by 37/107 (36.4%) of participants. CONCLUSION: In general, most participants agreed that the prevalence of AR appears to be increasing, with increased exposure to allergens, irritants, and pollutants as the main probable cause. Children and adolescents were accounted as the group most affected by AR, with sinusitis and asthma identified as the most frequent comorbidities. Finally, we found unmet needs in the diagnostic and management of AR that should be addressed among Ecuadorian ENTs, in particular the high use of CT scans as part of routine evaluations, as well as the low use of allergen immunotherapy.

Moving Beyond GDP: Cost Effectiveness of Cochlear Implantation and Deaf Education in Latin America.

HYPOTHESIS: Cochlear implantation (CI) and deaf education are cost effective management strategies of childhood profound sensorineural hearing loss in Latin America. BACKGROUND: CI has been widely established as cost effective in North America and Europe and is considered standard of care in those regions, yet cost effectiveness in other economic environments has not been explored. With 80% of the global hearing loss burden existing in low- and middle-income countries, developing cost effective management strategies in these settings is essential. This analysis represents the continuation of a global assessment of CI and deaf education cost effectiveness. METHODS: Brazil, Colombia, Ecuador, Guatemala, Paraguay, Trinidad and Tobago, and Venezuela participated in the study. A Disability Adjusted Life Years model was applied with 3% discounting and 10-year length of analysis. Experts from each country supplied cost estimates from known costs and published data. Sensitivity analysis was performed to evaluate the effect of device cost, professional salaries, annual number of implants, and probability of device failure. Cost effectiveness was determined using the World Health Organization standard of cost effectiveness ratio/gross domestic product per capita (CER/GDP)<3. RESULTS: Deaf education was very cost effective in all countries (CER/GDP 0.07-0.93). CI was cost effective in all countries (CER/GDP 0.69-2.96), with borderline cost effectiveness in the Guatemalan sensitivity analysis (Max CER/GDP 3.21). CONCLUSION: Both cochlear implantation and deaf education are widely cost effective in Latin America. In the lower-middle income economy of Guatemala, implant cost may have a larger impact. GDP is less influential in the middle- and high-income economies included in this study.

Quiste congénito del conducto nasolacrimal/dacrio-cistocele: causa de dacriocistitis no diagnosticada / Congenital cyst of nasolacrimal duct/dacriocistocele: cause of non-diagnosed dacriocistitis

RESUMEN Se presenta dos casos de pacientes menores de 5 meses los cuales durante las primeras semanas de vida presentan descarga ocular muco-purulenta de manera recurrente. Posteriormente en la endoscopia se encuentra en los dos casos masas quísticas intranasales dando un diagnóstico de dacriocistocele más quiste congénito del conducto nasolagrimal. El dacriocistocele es una causa muy rara de obstrucción del conducto nasal y más raro cuando viene acompañado de un quiste congénito del conducto nasolagrimal. Debido a su rareza y a su sintomatología muchas veces atípica resulta en un diagnóstico complicado para el otorrinolaringólogo y para el oftalmólogo.

ABSTRACT Two cases of patients younger than 5 months are presented, who during the first weeks of life have recurrent muco-purulent ocular dis-charge. Subsequently, in endoscopy, in both cases, intranasal cystic masses were found, resulting in a diagnosis of dacryocystocele plus congenital cyst of the lacrimal duct. Dacryocystocele is an uncommon cause of nasal duct obstruction, but it becomes less common when accompanied by a congenital tear duct cyst. Due to its uncommonness and its often-atypical symptoms, it results in a complicated diagnosis for the ENT and the ophthalmologist.

Efectos auditivos de la explosión del cuartel "La Balbina" de 1997

Se estudian 89 pacientes que estuvieron expuestos a la explosión accidental de una bodega de armas y municiones en un cuartel militar en Quito en 1997, estos pacientes se encontraban a una distancia que varió de unos pocos metros hasta 300 metros. Se valoró las lesiones auditivas que produo este trauma acústico en relación a la distancia en que se encontraban. La mayoría de lesiones auditivas se encuentran en estrcha relación con la distancia. Se analizan cada una de las lesiones y alteraciones audiométricas.

Vértigo posicional paroxístico benigno: incidencia diagnóstico y tratamiento

El Vértigo Posicional Paroxístico Benigno (VPPB) es una patología muy frecuente en nuestra serie responsable del 45 por ciento de casi de vértigo seguido en frecuencia por el Síndrome de Menieré. (39 por ciento). De 212 pacientes que acudieron a la consulta de otorrinolaringología por vértigo o mareo; 40 presentaron VPPB y 34 Síndrome de Menieré. 124 pacientes presentaron diferente diagnóstico o no se lo pudo confirmar. Su diagnóstico es básicamente clínico y a través de maniobras específicas, el tratamiento está basado en la realización de maniobras liberadoras y la rpesencia concomitantemente de medicación apropiada para resolver la sintomatología.

Tejido Adenoideo: un oculto reservorio bacteriano? / Adenoid Weave: hidden reservorio bacterial

Durante el periodo comprendido ente enero de 1995, a diciembre de 1996, se estudiaron 88 pacientes con hipertrofia adenoidea que fueron atendidos en los hospitales Baca Ortíz y Vozandes. Los pacientes tenían edades comprendidas entre 1 y 12 años, 44,31 por ciento pertenecían al sexo femenino y 55,58 por ciento al masculino. Los niños que presentaron sintomatología compatible con hipertrofia adenoidea y verificada la sospecha diagnóstica por RX, entraron al estudio. El tejido adenoideo fue enviado en suero fisiológico y procesado de acuerdo con normas estandar, identificación y antibiograma establecidas bajo normas microbiológicas. Dentro de los patógenos aislados, el stafilococus aureus, fue el más frecuente, segido por Haemaphilus influenzae. De acuerdo con la edad, los microorganismos varían así: en menores de 2 años el más frecuente Haemaphilus influenzae; entre 3 y 8 años el Stafilococus aureus...

Cirugía funcional endoscópica nasosinusal: resultados y complicaciones

Los problemas nasosinusales de tipo poliposis y sinusitis crónica que no responden a tratamiento clínico adecuado requieren de cirugía; desde 1993 los autores realizan una nueva técnica en el tratamiento de esta patología se trata de la cirugía funcional endoscópica naso-sinusal (CFENS), esta técnica se ha realizado en 94 pacientes en 13 patologías diferentes siendo las más frecuentes la poliposis naso-sinusal y la sinusitis crónica. Los resultados y complicaciones de esta técnica la hacen la elección para la gran mayoría de patología de los senos paranasales.