Laryngotracheal Complications after Intubation for COVID-19: A Multicenter Study.

Many of the patients with COVID-19 have suffered respiratory distress requiring prolonged endotracheal intubation (ETI) resulting in laryngotracheal complication with an impact on breathing, phonation, and swallowing. Our aim is to describe laryngeal injuries diagnosed after ETI in patients with COVID-19 in a multicentre study. METHODS: A prospective descriptive observational study was conducted from January 2021 to December 2021, including COVID-19 patients with laryngeal complications due to ETI diagnosed in several Spanish hospitals. We analyzed the epidemiological data, previous comorbidities, mean time to ICU admission and ETI, need for tracheostomy, mean time on invasive mechanical ventilation until tracheostomy or weaning, mean time in ICU, type of residual lesions, and their treatment. RESULTS: We obtained the collaboration of nine hospitals during the months of January 2021 to December 2021. A total of 49 patients were referred. Tracheostomy was performed in 44.9%, being late in most cases (more than 7-10 days). The mean number of days of ETI until extubation was 17.63 days, and the main post-intubation symptoms were dysphonia, dyspnea, and dysphagia, in 87.8%, 34.7%, and 42.9%, respectively. The most frequent injury was altered laryngeal mobility, present in 79.6%. Statistically, there is a greater amount of stenosis after late ETI and after delayed tracheostomy, not observing the data with the immobility alterations. CONCLUSION: The mean number of days of ETI was long, according to the latest guidelines, with the need for several cycles of pronation. This long ETI may have had an impact on the increase of subsequent laryngeal sequelae, such as altered laryngeal mobility or stenosis.

Kaolin particle films disrupt landing, settling behavior and feeding of Trioza erytrae on lemon plants.

BACKGROUND: The citrus greening disease or Huanglongbing (HLB) is the most devastating disease of citrus crops. Trioza erytreae is a vector of HLB. Since its introduction in Europe, the insect reached the northern region of Spain and the southern region of Portugal, threatening relevant citrus production areas. Limiting the spread of HLB vectors is mandatory to prevent this disease. In this work, we assessed the effect of kaolin, a white mineral clay, on the landing, settling behavior and feeding behavior of Trioza erytreae on lemon plants. RESULTS: After kaolin application, the number of plants on which the insect was found was significantly lower than on untreated plants in the laboratory and in the field. Moreover, there were significantly fewer T. erytreae and a shorter duration of phloem-related events on kaolin-treated than untreated plants. CONCLUSION: The use of kaolin could be a suitable and efficient tool for inclusion into integrated pest management programs or organic production to reduce populations of T. erytreae and subsequently limit the spread of HLB in citrus crops. © 2022 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.

Changes in listening habits and quality of musical sound after cochlear implantation.

OBJECTIVE: To evaluate listening habits and quality of musical sound after cochlear implantation. STUDY DESIGN: A total of 89 consecutive, adult, postlingually deafened, cochlear implant recipients entered the study. Music questionnaire included questions about musical background, listening habits, and quality of musical sound through cochlear implants. Music perception was evaluated with the Primary Measures of Music Audiation (PMMA). The questionnaire and the PMMA were administered to 67 and 65 patients, respectively. RESULTS: Listening habits significantly decreased postimplantation. The mean score (0-100) for the adjective pairs "like-dislike," "sounds like music-doesn't sound like music," "natural-mechanical," and "easy to follow-difficult to follow" was 60, 59, 50, and 40, respectively. The adjective pairs were associated with music enjoyment. Mean PMMA scores were 71 and 78 percent for tone and rhythm, respectively, with no association with music enjoyment. CONCLUSION: Music perception through a cochlear implant is a complex phenomenon that depends on audiological and non-audiological factors.

[Musical perception and enjoyment in post-lingual patients with cochlear implants]. / Percepción y disfrute de la música en pacientes poslocutivos con implante coclear.

OBJECTIVES: To evaluate music perception and enjoyment following cochlear implantation and its impact on quality of life (QOL). MATERIAL AND METHOD: Eighty-eight adult post-lingually deaf cochlear implant users entered the study. The music questionnaire analyzed musical background, listening habits, and quality of musical sound through the cochlear implant. Music perception was evaluated with the Primary Measures of Music Audiation (PMMA). The Glasgow Benefit Inventory evaluated the quality of life (QOL). The music questionnaires, the PMMA and the GBI were completed by 84 %, 74 %, and 82 % of patients, respectively. RESULTS: Subjective enjoyment of music and listening habits decreased post-implantation when compared with prior to deafness. Mean scores for music perception were: tone 71 %, rhythm 78 %, timbre 61 %, songs 59 %, and melodies 23 %. The quality of music sound through the cochlear implant was associated with music enjoyment and with QOL. CONCLUSIONS: Music enjoyment and perception are possible with a cochlear implant. The quality of music sound through the cochlear implant influences post-operative QOL.

Development and validation of a short version of the Spanish pediatric voice handicap index (P-VHI-10).

OBJECTIVES: A child's voice is used both as a tool for communication and as a form of emotional expression. Thus, voice disorders suffered by children have negative effects on their quality of life, which can be assessed using the "Pediatric Voice Handicap Index" (P-VHI). This questionnaire is completed by the parents of dysphonic patients and it has been validated in different languages: Italian, Korean, Arabic, and Spanish. More recently, the "Children Voice Handicap Index-10" test (C-VHI-10) was developed and validated, an Italian version reduced into 10 items that is answered by children themselves. The objective of this study was to develop and validate a short Spanish version of the P-VHI (P-VHI-10) and to assess whether it is comparable to the Italian C-VHI-10. MATERIALS AND METHODS: We conducted a cross-sectional study on 27 patients between 6-15 years of age. We developed an abbreviated version of the P-VHI that consisted of 10 statements to be answered by parents of children with dysphonia (P-VHI-10). These statements were based on the 10 items with the highest score in the validated Spanish version of the P-VHI. In addition, the validated Italian version of C-VHI-10 was translated into Spanish and this translation was reviewed and modified by three specialists, resulting in an adapted version to be answered by parents (C*-VHI-10). The parents and children included in the study of this index were the same patients as those included in the study to validate the Spanish P-VHI. RESULTS: There were no significant differences in the results obtained with the extended version of the P-VHI (17.4) and with the P-VHI-10 (18.7: Pearson coefficient = 0.602, p < 0.36). A paired student's t-test identified significant differences (p < 0.0001) when comparing the P-VHI-10 and C*-VHI-10, both of which were answered by parents, with average scores of 18.7 and 9.48, respectively. Both these reduced versions have good internal consistency, with a satisfactory Cronbach's alpha coefficient (α = 0.75 to P-VHI-10 and α = 0.73 in C*-VHI-10). No statistically significant differences were found when the average total score between the C-VHI-10 and C*-VHI-10 were compared, with a Pearson's correlation coefficient of 0.559 (p < 0.9). CONCLUSION: The short version of the P-VHI10 questionnaire is a clinically valid tool that has good internal consistency.

Current indications for the osteoplastic flap.

INTRODUCTION AND OBJECTIVES: Endoscopic sinus surgery is the technique of choice in most of the frontal sinus diseases, both inflammatory and tumour-related. This is why the external approach using osteoplastic flap (OF) would be limited to cases with a difficult endoscopic approach. Our aim was to review the current indications of the osteoplastic flap in the treatment of frontal sinus pathology, through a retrospective study of patients undergoing this technique. METHODS: We performed a retrospective study of 14 patients who were treated with the osteoplastic flap procedure. All the surgical indication criteria, type of sinus disease, presence or absence of prior endoscopic surgery, surgical findings, complications and recurrence were reviewed. RESULTS: The pathologies found were 1 osteoma (7.1%), 3 inverted papilloma (21.4%) and 10 mucoceles (71.4%). Nine patients had a prior endoscopic surgery and 10 patients had an orbital dehiscence (9 mucocele, 1 papilloma). Frontal osteoma was Grade IV and the papilloma cases were Krouse Stage III. Surgical revision was required for 21.4%. CONCLUSIONS: The main indications for an OF in patients with inflammatory disease are lateral extension and frontal recess neo-osteogenesis. In osteoma cases, it depends on the size of the tumour. In inverted papilloma cases, the indication is multifocal implantation with origin in the anterior and lateral wall. In all cases, performing the osteoplastic flap must be individualised.

E-cadherin downregulation sensitizes PTEN-mutant tumors to PI3Kß silencing.

Alterations in phosphatidylinositol 3-kinase (PI3K) and in PTEN (phosphatase and tensin homolog), the negative regulator of the PI3K pathway, are found in nearly half of human tumors. As PI3Kß, the main isoform activated in PTEN-mutant tumors, has kinase-dependent and -independent activities, we compared the effects of depleting vs. drug-inhibiting PI3Kß kinase activity in a collection of diverse tumor types and in a set of bladder carcinoma cell lines grown as xenografts in mice. PI3Kß depletion (by intratumor injection of PIK3CB siRNA) induced apoptosis and triggered regression of PTEN-mutant tumors more efficiently than PI3Kß inhibition. A small proportion of these tumors was resistant to PI3Kß downregulation; we analyzed what determined resistance in these cases. Using add-back experiments, we show that both PTEN mutation and low E-cadherin expression are necessary for PI3Kß dependence. In bladder carcinoma, loss of E-cadherin expression coincides with N-cadherin upregulation. We found that PI3Kß associated with N-cadherin and that PIK3CB depletion selectively disrupted N-cadherin cell adhesions in PTEN-mutant bladder carcinoma. These results support the use of PIK3CB interfering RNA as a therapeutic approach for high-risk bladder cancers that show E-cadherin loss and express mutant PTEN.

Adaptation and validation of Spanish version of the pediatric Voice Handicap Index (P-VHI).

OBJECTIVES: The voice in childhood is a communication tool and a form of emotional expression. It is estimated that 6 to 23% of children may have voice disorders. There is a test, the Pediatric Voice Handicap Index (P-VHI), validated in English to assess the specific impact on quality of life of children with speech pathology. Spanish is the second most widely used language in the world in terms of number of speakers, with over 500 million native speakers, so it is necessary to have tools that allow us to evaluate the effects of dysphonia in Spanish-speaking children. The aim of our study is the validation of the Spanish version of the P-VHI. MATERIAL AND METHODS: We performed a cross-sectional study including patients between 4 and 15 years of age. The English P-VHI validated version was translated into Spanish and this translation was reviewed and modified by three specialists in Otorhinolaryngology. There were two study groups, children who had dysphonia (n=44) and a control group of children without alterations in voice (n=44). The questionnaire was always answered by parents. RESULTS: Significant differences were found between the group of children with dysphonia and the control group in the overall P-VHI score and the different subscales (p<0.001). Optimal internal consistency with a good Cronbach's alpha (α=0.81) was found, with high test-retest reliability (Wilcoxon z: -0847, p>0.05). CONCLUSIONS: The Spanish version of the P-VHI is a validated tool that has good internal consistency. It is a reliable test that evaluates the Voice Handicap Index in the pediatric population, with easy application for daily clinical practice.

Corrigendum to: Swept-sine noise-induced damage as a hearing loss model for preclinical assays.

[This corrects the article on p. 7 in vol. 7, PMID: 25762930.].

Swept-sine noise-induced damage as a hearing loss model for preclinical assays.

Mouse models are key tools for studying cochlear alterations in noise-induced hearing loss (NIHL) and for evaluating new therapies. Stimuli used to induce deafness in mice are usually white and octave band noises that include very low frequencies, considering the large mouse auditory range. We designed different sound stimuli, enriched in frequencies up to 20 kHz ("violet" noises) to examine their impact on hearing thresholds and cochlear cytoarchitecture after short exposure. In addition, we developed a cytocochleogram to quantitatively assess the ensuing structural degeneration and its functional correlation. Finally, we used this mouse model and cochleogram procedure to evaluate the potential therapeutic effect of transforming growth factor ß1 (TGF-ß1) inhibitors P17 and P144 on NIHL. CBA mice were exposed to violet swept-sine noise (VS) with different frequency ranges (2-20 or 9-13 kHz) and levels (105 or 120 dB SPL) for 30 min. Mice were evaluated by auditory brainstem response (ABR) and otoacoustic emission tests prior to and 2, 14 and 28 days after noise exposure. Cochlear pathology was assessed with gross histology; hair cell number was estimated by a stereological counting method. Our results indicate that functional and morphological changes induced by VS depend on the sound level and frequency composition. Partial hearing recovery followed the exposure to 105 dB SPL, whereas permanent cochlear damage resulted from the exposure to 120 dB SPL. Exposure to 9-13 kHz noise caused an auditory threshold shift (TS) in those frequencies that correlated with hair cell loss in the corresponding areas of the cochlea that were spotted on the cytocochleogram. In summary, we present mouse models of NIHL, which depending on the sound properties of the noise, cause different degrees of cochlear damage, and could therefore be used to study molecules which are potential players in hearing loss protection and repair.

Drug delivery to the inner ear: strategies and their therapeutic implications for sensorineural hearing loss.

Hearing aids or cochlear implants constitute almost exclusively the treatment options currently available to patients suffering from sensorineural hearing loss and related conditions, such as noise-induced hearing loss, ototoxicity or autoimmune inner ear disease. While some systemic treatments exist, they generally exert adverse secondary effects and their efficacy is hampered by the blood-cochlear barrier that limits drug access to the inner ear. Hence, the new therapies that are being developed for hearing loss focus on strategies for direct drug delivery to the inner ear. The passive and active methods for local delivery can be categorized into two general groups: intratympanic or intracochlear. The intratympanic approach is a non-invasive method that preserves hearing and takes advantage of the permeability of the round window to gain access to the cochlea. However, this technique is limited by not knowing the dose of the drug that reaches the cochlea, (a handicap which might be overcome by the use of tagged drugs). While direct access to the inner ear by intracochlear administration avoids this problem, this method requires surgery. Currently, laboratory animals are being used to explore which therapeutic approaches are best suited to address this problem. These include cochleostomy and the insertion of devices that pump drugs into the inner ear without inducing cochlear damage. In this article, we review the different techniques under evaluation in animal models of deafness, and their potential use for drug delivery and treatment of human inner ear diseases.

[Correlation between active anterior rhinomanometry and nasal endoscopy]. / Correlación entre la rinomanometría anterior activa y la endoscopia nasal.

OBJECTIVE: Nasal permeability is related to functional and anatomical parameters, which are objectified by active anterior rhinomanometry (AARNM). The study aims to compare alterations visualized through Nasal Endoscopy (NE) with nasal flow parameters in AARNM. MATERIAL AND METHODS: We carried out a prospective observational study of 45 patients suffering from nasal obstruction and septal deviation. They were explored through AARNM and NE, and the deviations were classified into anterosuperior and anteroinferior quadrants. The degree of agreement between observers and the validity of the diagnostic test was then analyzed. RESULTS: A sensitivity of 74.6% and a specificity of 60.5% were obtained comparing AARNM and EN globally. CONCLUSION: A reduced flow of the expiratory phase is correlated to inferior obstructions observed through NE. In the narrow nasal vestibule this correlation is not predictive.