Blue laser for the exclusive endoscopic transcanal approach to middle ear paraganglioma.

BACKGROUND: The management of glomus tympanicum tumours can be challenging. Blue laser coagulation may improve bleeding control thus facilitating an endoscopic transcanal excision. The objective of this presentation is to illustrate the authors' experience using this novel tool. METHODS: Case report of a patient that underwent exclusive endoscopic transcanal blue laser surgery of a class A2 glomus tympanicum tumour in a tertiary referral center. CONCLUSION: The present study provides evidence of the safety and efficacy of endoscopic blue laser surgery, for the minimally invasive treatment of early-stage glomus tympanicum tumours.

Palisade cartilage tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for transcanal endoscopic treatment of subtotal tympanic membrane perforations: a retrospective study.

PURPOSE: The endoscopic approach to tympanoplasty is gaining popularity, but its adoption for the palisade tympanoplasty technique is unstudied. The aim of the present study was to evaluate the effectiveness of endoscopic cartilage palisade tympanoplasty compared to one-piece composite cartilage-perichondrium grafts for tympanic membrane closure in adult patients with subtotal perforations. METHODS: Retrospective study of 42 adult patients who underwent endoscopic tympanoplasty for a subtotal perforation in a university tertiary referral center from January 2018 to June 2019. Patients underwent transcanal tympanoplasty either with cartilage palisade grafts or with one-piece composite cartilage-perichondrium grafts. Both techniques were compared for graft take rate and audiometric results. RESULTS: Twenty palisade and 22 single-piece tympanoplasties were analyzed. No statistically significant differences between groups were found in terms of tympanic membrane closure (85% vs. 86.3%, p = 0.5) or hearing improvement. CONCLUSION: The results of the present study suggest that similar results can be obtained with palisade cartilage grafts compared to the one-piece composite cartilage-perichondrium technique for endoscopic tympanic membrane closure. Further studies with long-term results will be needed to confirm these findings.

Long-Term Hearing Outcomes following Stapedotomy in Patients with Otosclerosis and Preoperative Small Air-Bone Gap.

OBJECTIVES: To assess the long-term effectiveness of stapedotomies performed on patients with otosclerosis and preoperative small air-bone gaps (ABGs). METHODS: Retrospective study comparing the 10-year postoperative hearing outcomes after primary stapedotomies in patients with small (≤20 dB) and large ABGs (> 20 dB). Ninety out of 175 stapedotomies (22 and 68 in the small and large ABG groups, respectively) were monitored with long-term follow-ups. RESULTS: Ten years after the operation, hearing measurements were similar for both groups, although a significant decline of bone conduction thresholds was evident (p = 0.007 and p < 0.001, respectively). An improvement of ≥10 dB in the postoperative ABG (clinical improvement) was achieved only in the large ABG group. CONCLUSIONS: Even though long-term hearing levels will evolve similarly in patients with ≤20 and > 20 dB preoperative ABGs, the lack of clinical improvement found in the small ABG group is not in favor of an early surgery.

Adaptation and validation of the Spanish version of the Nasal Obstruction Symptom Evaluation (NOSE) Scale.

BACKGROUND: The Nasal Obstruction Symptom Evaluation (NOSE) scale is a symptom-specific, self-completed questionnaire for assessing quality of life related to nasal obstruction or its treatment in patients with septal deviation. The aim of this study was to validate the Spanish adaptation of the NOSE, thus allowing comparison across studies and international multicenter projects. METHODOLOGY: Multicenter prospective instrument validation study. Guidelines for the cross-cultural adaptation process from the original English language scale into a Spanish language version were followed. The psychometric properties (reproducibility, reliability, validity, responsiveness) of the Spanish version ("NOSE-e" for "NOSE-espanol") were assessed in 58 consecutive patients undergoing septoplasty (both before and 3 months after surgery) and 58 matched asymptomatic controls. RESULTS: Test-retest reliability and internal consistency reliability were adequate. The NOSE-e demonstrated satisfactory construct validity. Positive correlations between the NOSE-e scores and the score of a visual analog scale measuring the subjective sensation of nasal obstruction were found. The instrument showed excellent between-groups discrimination and high response sensitivity to change. CONCLUSIONS: The Spanish version of the NOSE (NOSE-e) is a valid tool for measuring the subjective severity of nasal obstruction, and its use is recommended.

The cost associated with interstitial thermotherapy for tonsil reduction vs. standard tonsillectomy.

Given the high demand for tonsillectomies in children, the variety of techniques available, and the increasing need to control expenditures, it is important to analyse the costs associated with surgical procedures. The aim in the present study was to compare the cost of interstitial thermotherapy for tonsil volume reduction with conventional tonsillectomy. This was a nonrandomized, retrospective analysis at a public practice regional hospital between 2010 and 2012. Paediatric patients that underwent molecular resonance (MR)-induced tonsil thermal ablation (day case admission) were matched, according to age and concurrent surgery, to patients that underwent tonsillectomy by standard bipolar dissection (ordinary admission) during the same study period. Both groups were compared in economic terms based on operating room (OR) times, salaries, materials and hospitalization cost. Sixty-two patients were included (31 in each group). The mean ages of patients in the MR and tonsillectomy groups were 5.6 (2.7 SD) and 5.1 years (2.0 SD), respectively. A significantly lower mean surgery time (28.25 vs. 36.95 min), anaesthesia time (48.79 vs. 61.73 min), OR time (64.18 vs. 76.16 min), and OR cost (€166.60 vs. €199.58) were found in the MR group (P < 0.05). The mean cost-per-patient was significantly higher in the MR technique when the expenses of the single-use probe and the overnight stay were, respectively, added (€408.60 vs. €374.58, P = 0.007). The present study confirmed increased costs for interstitial thermotherapy for tonsil reduction compared to conventional tonsillectomy. Operation time and early discharge savings were eclipsed by the cost of the disposable probes.

Bell's palsy and COVID-19: A cohort study with historical rate comparison.

INTRODUCTION: During the SARS-CoV-2 pandemic, immune-mediated neurological events have been described in patients vaccinated against the virus or who have overcome the disease. Among these events is Idiopathic peripheral facial palsy or Bell's palsy. OBJECTIVES: To study the incidence of Bell's Palsy in the ENT emergency department of a tertiary hospital in Catalonia during the SARS-CoV-2 pandemic. METHODS: Retrospective historical cohort comparison study of patients diagnosed with Bell's palsy between January 2018 and December 2021. Crude incidence rates were calculated as the total number of events divided by person time at risk per 100.000 person-years. Observed (2020, 2021) and historical (2018, 2019) rates were compared using standardized incidence rates with corresponding 95% confidence intervals. RESULTS: Of the total number of ENT emergency department visits from 2018 to 2021 (22.658), there were 247 cases of Bell's palsy. The incidence rate of Bell's palsy in the pre-pandemic group was 12,2 and 10,9 per 100.000 person-years for 2018 and 2019, respectively. The 2020 standardized incidence rate of Bell's palsy was 0,70 [95% CI 0,49-1,01] and 1,25 [95% CI 0,93-1,67] for 2021. No significant differences were evident between the two groups. CONCLUSION: In our cohort, no association was found between vaccination or COVID-19 infection and the development of Bell's Palsy.

Current approaches to facial nerve schwannoma surgery.

Background: Facial nerve schwannomas (FNSs) are exceedingly rare benign tumors. This study aims to report on a series of excised FNSs, providing clinical information and details on their surgical management, including novel approaches. Methods: We retrospectively reviewed patients who underwent surgical excision of FNSs in a private otology clinic and public tertiary referral center. The main outcome measures were facial nerve function, complete tumor removal, postoperative complications, tumor recurrence, and hearing. Results: Seventeen patients (10 men and 7 women) with a mean age of 44.23 years (SD, 12.21) underwent surgery during the study period. The most common symptom was facial nerve dysfunction (58.8%). Facial and otoneurologic symptoms (hearing loss, tinnitus, and vertigo) were observed in 88.8% and 77.7% of patients, respectively. The middle cranial fossa (MCF) was the most common approach (six patients, 35.2%), followed by translabyrinthine (TL), transmastoid (TM), and combined TM-MCF (three patients, 17.6% each). Exclusive endoscopic transcanal suprageniculate (ETS) and mastoid combined with cervical approaches were applied once in two patients, 5.8% each. Total tumor removal was achieved in all cases. No significant postoperative complications were observed. The mean follow-up period was 193.2 months (SD, 119.5) and no tumor recurrence was observed. Conclusion: This study provides further evidence for the safety and efficacy of various surgical approaches for FNS, and incorporates the endoscopic transcanal approach. Level of evidence: 4.

Transcanal endoscopic carbon dioxide laser resection of early-stage (A1-B1) glomus tympanicum tumours: single-centre case series.

OBJECTIVE: To report a single-centre experience in the endoscopic carbon dioxide laser-assisted approach to glomus tympanicum tumours. METHODS: A retrospective case review was conducted of patients diagnosed with class A1 to B1 glomus tympanicum tumours who underwent exclusive transcanal endoscopic carbon dioxide laser surgery. RESULTS: Seven patients fulfilled the inclusion criteria. All patients (100 per cent) were women, with a mean age of 65.4 years (standard deviation, 13.6). There were five A2 tumours, one A1 tumour and one B1 tumour. One patient presented with a delayed tympanic membrane perforation needing myringoplasty on follow up. There were no substantial post-operative complications. The mean hospitalisation time was 9.5 hours (standard deviation, 9.8). The mean follow-up period was 32.7 months (standard deviation, 13.1), with all cases having resolution of pulsatile tinnitus and no tumour recurrence. CONCLUSION: The study provides further evidence on the safety and efficacy of endoscopic carbon dioxide laser surgery as a minimally invasive technique for treating early-stage glomus tympanicum tumours.

Nuances in transcanal endoscopic approach to benign middle ear tumours in adult patients.

BACKGROUND AND OBJECTIVE: Minimally invasive surgery of benign middle ear tumours is possible by using the endoscope. The optimal lighting and the broadest vision it offers, allow a transcanal approach to these rare tumours. The objective of this work is to summarise its key points through a case series. MATERIALS AND METHODS: Retrospective study of benign middle ear tumours that underwent exclusive endoscopic surgery in a third-level adult university hospital between June 2018 and June 2020. Postoperative follow-up was performed by otoendoscopy and audiometry. RESULTS: Six patients underwent surgery during the study period. Five patients were female and one male, with an average age of 57.8 years (±21.9). Four tumours were in the left ear and 2 in the right ear. These included four tympanic paragangliomas (three type I and one type II), a chorda tympani neuroma, and a congenital cholesteatoma. There were no serious postoperative complications. At present, no tumour recurrence has been found in either case, with a minimum follow-up of 7 months. CONCLUSIONS: The present study adds evidence on the safety and efficacy of endoscopic transcanal ear surgery, as a minimally invasive technique, for the treatment of benign middle ear tumours confined to the tympanic cavity.

Adaptation and initial validation of the Spanish version of the chronic otitis media questionnaire-12 (COMQ-12) and chronic otitis media benefit inventory (COMBI).

BACKGROUND AND OBJECTIVES: The chronic otitis media questionnaire-12 (COMQ-12) and chronic otitis media benefit inventory (COMBI) aim to assess the quality of life related to chronic otitis media or its surgical treatment. The objective of this study was to validate the Spanish adaptation of the COMQ-12 and COMBI. PATIENTS AND METHODS: Multicentre prospective instrument validation study. guidelines for the cross-cultural adaptation process were followed. The psychometric properties of the Spanish versions ("COMQ-12-Spa" for "COMQ-12-Spanish" and "COMBI-Spa" for "COMBI-Spanish") were assessed in 25 consecutive adults undergoing tympanoplasty and in a separate cohort of 25 unaffected adults. RESULTS: COMQ-12-Spa: test-retest reliability, r=0.98; internal consistency reliability, α=0.92. Item-subscale and item-total coefficients, ≥0.40. Between-group discrimination, p<0.0001. COMBI-Spa: internal consistency, α=0.96. A high-intensity relationship between the variables was shown, ≥0.40. Correlation between the COMBI-Spa and the Spanish Glasgow Benefit Inventory (GBI), r=0.89; p<0.01. CONCLUSION: Psychometric testing of the Spanish versions of the COMQ-12-Spa and COMBI-Spa yielded satisfactory results, thus allowing pre- and postintervention assessment of the subjective severity of chronic otitis media in adult patients.

Nuances in transcanal endoscopic approach to benign middle ear tumours in adult patients. / Particularidades del abordaje transcanal endoscópico de los tumores benignos de oído medio en adultos.

BACKGROUND AND OBJECTIVE: Minimally invasive surgery of benign middle ear tumours is possible by using the endoscope. The optimal lighting and the broadest vision it offers, allow a transcanal approach to these rare tumours. The objective of this work is to summarize its key points through a case series. MATERIALS AND METHODS: Retrospective study of benign middle ear tumours that underwent exclusive endoscopic surgery in a third-level adult university hospital between June 2018 and June 2020. Postoperative follow-up was performed by otoendoscopy and audiometry. RESULTS: Six patients underwent surgery during the study period. Five patients were female and one male, with an average age of 57.8 years (± 21.9). Four tumours were in the left ear and 2 in the right ear. These included 4tympanic paragangliomas (3 type I and one type II), a chorda tympani neuroma, and a congenital cholesteatoma. There were no serious postoperative complications. At present, no tumour recurrence has been found in either case, with a minimum follow-up of 7 months. CONCLUSIONS: The present study adds evidence on the safety and efficacy of endoscopic transcanal ear surgery, as a minimally invasive technique, for the treatment of benign middle ear tumours confined to the tympanic cavity.

Timing, Complications, and Safety of Tracheotomy in Critically Ill Patients With COVID-19.

IMPORTANCE: The current coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented needs for invasive ventilation, with 10% to 15% of intubated patients subsequently requiring tracheotomy. OBJECTIVE: To assess the complications, safety, and timing of tracheotomy performed for critically ill patients with COVID-19. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study assessed consecutive patients admitted to the intensive care unit (ICU) who had COVID-19 that required tracheotomy. Patients were recruited from March 16 to April 10, 2020, at a tertiary referral center. EXPOSURES: A surgical tracheotomy was performed for all patients following recommended criteria for use of personal protective equipment (PPE). MAIN OUTCOMES AND MEASURES: The number of subthyroid operations, the tracheal entrance protocol, and use of PPE. Infections among the surgeons were monitored weekly by reverse-transcriptase polymerase chain reaction of nasopharyngeal swab samples. Short-term complications, weaning, and the association of timing of tracheotomy (early [≤10 days] vs late [>10 days]) with total required days of invasive ventilation were assessed. RESULTS: A total of 50 patients (mean [SD] age, 63.8 [9.2] years; 33 [66%] male) participated in the study. All tracheotomies were performed at the bedside. The median time from intubation to tracheotomy was 9 days (interquartile range, 2-24 days). A subthyroid approach was completed for 46 patients (92%), and the tracheal protocol was adequately achieved for 40 patients (80%). Adequate PPE was used, with no infection among surgeons identified 4 weeks after the last tracheotomy. Postoperative complications were rare, with minor bleeding (in 6 patients [12%]) being the most common complication. The successful weaning rate was higher in the early tracheotomy group than in the late tracheotomy group (adjusted hazard ratio, 2.55; 95% CI, 0.96-6.75), but the difference was not statistically significant. There was less time of invasive mechanical ventilatory support with early tracheotomy compared with late tracheotomy (mean [SD], 18 [5.4] vs 22.3 [5.7] days). The reduction of invasive ventilatory support was achieved at the expense of the pretracheotomy period. CONCLUSIONS AND RELEVANCE: In this cohort study, with the use of a standardized protocol aimed at minimizing COVID-19 risks, bedside open tracheotomy was a safe procedure for patients and surgeons, with minimal complications. Timing of tracheotomy may be important in reducing time of invasive mechanical ventilation, with potential implications to intensive care unit availability during the COVID-19 pandemic.

Adaptation and validation of the Spanish version of the Tonsil and Adenoid Health Status Instrument.

OBJECTIVES/HYPOTHESIS: The Tonsil and Adenoid Health Status Instrument (TAHSI) is a disease-specific questionnaire, intended for completion by parents, for assessing quality of life related to tonsil and adenoid disease or its treatment in children with throat disorders. The aim of this study was to validate the Spanish adaptation of the TAHSI, thus allowing comparison across studies and international multicenter projects. STUDY DESIGN: Multicenter prospective instrument validation study. METHODS: Guidelines for the cross-cultural adaptation process from the original English-language scale into a Spanish-language version were followed. The psychometric properties (reproducibility, reliability, validity, responsiveness) of the Spanish version of the TAHSI (s-TAHSI) were assessed in 51 consecutive children undergoing adeno/tonsillectomy (both before and 6 months after surgery) and a separate cohort of 50 unaffected children of comparable age range. RESULTS: Test-retest reliability (γ = 0.8) and internal consistency reliability (α = 0.95) were adequate. The s-TAHSI demonstrated satisfactory content validity (r > 0.40). The instrument showed excellent between-groups discrimination (P < .0001) and high responsiveness to change (effect size = 2.09). CONCLUSIONS: Psychometric testing of the s-TAHSI yielded satisfactory results, thus allowing assessment of the subjective severity of throat disorders in children. LEVEL OF EVIDENCE: 2c. Laryngoscope, 128:1469-1475, 2018.

Development and evaluation of an audiology app for iPhone/iPad mobile devices.

CONCLUSION: The application described in this study appears to be accurate and valid, thus allowing calculation of a hearing handicap and assessment of the pure-tone air conduction threshold with iPhone/iPad devices. OBJECTIVE: To develop and evaluate a newly developed professional, computer-based hearing handicap calculator and a manual hearing sensitivity assessment test for the iPhone and iPad (AudCal). METHODS: Multi-center prospective non-randomized validation study. One hundred and ten consecutive adult participants underwent two hearing evaluations, a standard audiometry and a pure-tone air conduction test using AudCal with an iOS device. The hearing handicap calculation accuracy was evaluated comparing AudCal vs a web-based calculator. RESULTS: Hearing loss was found in 83 and 84 out of 220 standard audiometries and AudCal hearing tests (Cohen's Kappa = 0.89). The mean difference between AudCal and standard audiogram thresholds was -0.21 ± 6.38 dB HL. Excellent reliability and concordance between standard audiometry and the application's hearing loss assessment test were obtained (Cronbach's alpha = 0.96; intra-class correlation coefficient = 0.93). AudCal vs a web-based calculator were perfectly correlated (Pearson's r = 1).

[Prevalence of aphysiologic performance on dynamic posturography in work-related patients]. / Prevalencia de test afisiológicos de posturografía dinámica en pacientes laborales.

INTRODUCTION AND OBJECTIVES: Medical-legal implications of dizziness and imbalance in work-related patients are important. In these cases, computerized dynamic posturography (CDP) adds information to standard vestibular tests and aphysiologic patterns have been described. The objective is to assess the prevalence of aphysiologic performance on CDP in work-related patients complaining of dizziness/imbalance. MATERIAL AND METHODS: Retrospective review of patients referred by the workers' compensation board for assessment of dizziness, imbalance or both. Standard vestibular assessment including CDP was carried out in all patients. The sensory organization test (SOT) summaries were scored as normal, aphysiologic or vestibular using the scoring method published by Cevette et al. in 1995. RESULTS: Aphysiologic performance in SOT, evaluated with the Cevette formula, was found in 31 out of 100 cases. Low composite score results and aphysiologic SOT results had a statistically-significant association (P=.01). Videonystagmography (VNG) was altered in 14 out of 31 cases with aphysiologic SOT. CONCLUSION: The 31% prevalence of aphysiologic results on CDP among work-related patients complaining of dizziness/imbalance is relatively high in comparison with the 25% published by Longridge and Mallinson in 2005. However, aphysiologic performance should not necessarily be related to malingering or exaggeration and altered vestibular tests are found in some of these cases.