Elaboración de una escala de puntuación predictiva de infección periamigdalina basada en signos y síntomas / Design of a predictive score table for peritonsillar infection based on signs and symptoms

Introducción La infección periamigdalina (IPA) supone un motivo de consulta urgente entre las molestias de garganta. Un diagnóstico diferido o incorrecto puede comprometer la vía aerodigestiva alta y resultar mortal en su evolución. Nuestro objetivo fue desarrollar un modelo predictivo de presencia de IPA que ayude en su rápida detección. Pacientes y métodos Un estudio observacional retrospectivo de 66 meses desde 2017 fue desarrollado en un hospital comarcal y su centro terciario de referencia, recogiendo datos de todos los pacientes diagnosticados de IPA y un volumen proporcional de sujetos con sintomatología faríngea sin IPA. Recopilación de datos clínicos, exploratorios y demográficos entre participantes. Su mayor riesgo relativo de presencia de IPA los etiquetó como variables a testar. Elaboración de una escala de puntuación de probabilidad de padecerla y análisis de regresión logística, con obtención de la curva ROC que ofreciera mejor correlación diagnóstica. Validación interna y cálculo de los valores predictivos de este modelo. Resultados Sobre 348 casos de IPA, la escala de valoración puntuó la presencia de 6 variables: trismus (3), disfagia-odinofagia unilateral (2), abombamiento velar (2), otalgia refleja (1), faringolalia (1) y edad de 16-46 años (1). Con un rango de 0 a 10, un cut-off≥6 ofreció una sensibilidad del 96,1%, una especificidad del 93,9% y una eficienca del 94,9%. El área bajo la curva ROC fue de 0,979. Conclusiones La validación interna de este modelo basado en signos y síntomas la faculta como herramienta muy útil para detectar precozmente IPA en otorrinolaringología y atención primaria (AU)

Background Peritonsillar infection (PTI) is a reason for urgent consultation due to intense throat discomfort. A delayed or inaccurate diagnosis can jeopardize the upper aerodigestive tract and be fatal in its evolution. Our objective was to develop a predictive model for the presence of IPA helping in its rapid detection. Patients and methods A 66-month retrospective observational study from 2017 was carried out in a county and tertiary referral hospitals, registering data from all patients diagnosed with PTI and a proportional volume of subjects with pharyngeal symptoms without PTI. Collection of clinical, exploratory and demographic data among participants. Their higher relative risk of PTI presence allowed them to be considered as variables to be tested. Development of a scoring scale for the probability of suffering from it and logistic regression analysis, obtaining the ROC curve with the best diagnostic correlation. Internal validation and estimation of the predictive values of the model. Results On 348 cases of PTI, the assessment scale scored the presence of six variables: trismus (3), unilateral dysphagia-odynophagia (2), velar bulging (2), reflex otalgia (1), pharyngolalia (1) and age between 16 and 46 years (1). With a range of 0-10, a cut-off ≥6 offered a sensitivity of 96.1%, a specificity of 93.9%, and an efficiency of 94.9%. The area under the ROC curve was 0.979. Conclusions The internal validation of this model based on signs and symptoms makes it a very useful tool for early detection of PTI in otorhinolaryngology and primary care (AU)

[Design of a predictive score table for peritonsillar infection based on signs and symptoms]. / Elaboración de una escala de puntuación predictiva de infección periamigdalina basada en signos y síntomas.

BACKGROUND: Peritonsillar infection (PTI) is a reason for urgent consultation due to intense throat discomfort. A delayed or inaccurate diagnosis can jeopardize the upper aerodigestive tract and be fatal in its evolution. Our objective was to develop a predictive model for the presence of IPA helping in its rapid detection. PATIENTS AND METHODS: A 66-month retrospective observational study from 2017 was carried out in a county and tertiary referral hospitals, registering data from all patients diagnosed with PTI and a proportional volume of subjects with pharyngeal symptoms without PTI. Collection of clinical, exploratory and demographic data among participants. Their higher relative risk of PTI presence allowed them to be considered as variables to be tested. Development of a scoring scale for the probability of suffering from it and logistic regression analysis, obtaining the ROC curve with the best diagnostic correlation. Internal validation and estimation of the predictive values of the model. RESULTS: On 348 cases of PTI, the assessment scale scored the presence of six variables: trismus (3), unilateral dysphagia-odynophagia (2), velar bulging (2), reflex otalgia (1), pharyngolalia (1) and age between 16 and 46 years (1). With a range of 0-10, a cut-off ≥6 offered a sensitivity of 96.1%, a specificity of 93.9%, and an efficiency of 94.9%. The area under the ROC curve was 0.979. CONCLUSIONS: The internal validation of this model based on signs and symptoms makes it a very useful tool for early detection of PTI in otorhinolaryngology and primary care.

False positive for ß2-transferrin in rhinorrhoea. Ocular trauma. / Un falso positivo para ß2-transferrina en rinorrea. Traumatismo ocular.

Ocular perforations require an action depending on the findings observed. Additionally, the closeness of the orbit to the nasal cavity and the anterior cranial fossa requires any collateral damage in these spaces to be ruled out. The presence of a penetrating ocular injury associated with ipsilateral rhinorrhoea in which the presence of ß2-transferrin -a highly specific and sensitive marker to identify cerebrospinal fluid- is detected, obliges to suspect and locate any possible leakage. A case is presented in which this unbound protein is detected in post-traumatic rhinorrhoea with an origin in the eyeball, making the diagnosis of a CSF leak into a false positive.

[Effect of smoking withdrawal on hearing loss induced by occupational exposure to noise. A preliminary study]. / Efecto de la supresión del tabaco en la hipoacusia inducida por ruido laboral. Estudio preliminar.

Smoking and occupational exposure to noise are factors with independent predisposition to sensorineural hearing loss. This is a sinergistic and additive effect. Nevertheless, we have observed that withdrawal of smoking stops the progression on hearing loss in occupational groups with an acoustic exposition lesser than 80 dB SPL. Actually, there is not an unique ethiologic hypothesis.

[Management of peritonsillar infections]. / Tratamiento de la infección periamigdalina.

OBJECTIVE: To evaluate the clinical and epidemiologic characteristics in children with peritonsillar infections. PATIENTS AND METHODS: A longitudinal retrospective study was performed through a review of the clinical histories of patients attending the emergency unit in the previous 6 years. The variables gathered were age, sex, recurrent tonsillitis, previous upper airway infection, antibiotic administration, and therapeutic approach. RESULTS: Twenty-nine children were admitted, with a mean age of 7.4 +/- 1.6 years (boys 1.6:1). Twenty-seven percent had recurrent tonsillitis. At the visit, 57.8 % had an upper respiratory infection and 65 % were taking antibiotic treatment, especially macrolides. The treatment selected at our center consisted of the association of penicillin or amoxicillin-clavulanate acid with clindamycin, including corticosteroids. Ten children underwent computed tomography and nine underwent fine-needle aspiration. Drainage was performed in 20.6 % of confirmed abscesses. The mean length of hospital stay was 5.6 +/- 1.6 days. Delayed tonsillectomy was performed in 31 %, except in one patient who developed a parapharyngeal abscess. Currently, 18.9 % of all peritonsillar infections occur in the pediatric population. CONCLUSIONS: The increase in these infections is probably related to inappropriate use of antibiotics in respiratory diseases. Diagnosis is clinical, and infections are often resolved by intravenous administration of beta-lactams with clindamycin and an expectant attitude. When an abscess is suspected or there is no clinical improvement, fine-needle aspiration or computed tomography is warranted and drainage should be performed if an abscess is confirmed. Tonsillectomy, usually delayed, is only indicated in patients with recurrent tonsillitis.

Tratamiento de la infección periamigdalina / Management of peritonsillar infections

Objetivo Analizar las características clínicas y epidemiológicas de niños afectados de infección periamigdalar. Pacientes y métodos Estudio longitudinal y restrospectivo de revisión de historias clínicas en los casos detectados los últimos 6 años atendidos en Urgencias. Se anotaron las variables de edad, sexo, amigdalitis de repetición, catarro previo de vías altas, administración de antibiótico y actitud terapéutica adoptada. Resultados Fueron ingresados 29 niños cuya edad media era de 7,4 +/- 1,6 años (varones 1,6:1). El 27 % cursaba con amigdalitis de repetición y el 57,8 % con catarro en el momento de la consulta, de los que el 65 % llevaba tratamiento antibiótico, especialmente macrólidos. El tratamiento seleccionado en nuestro centro fue la asociación penicilina o amoxicilina-ácido clavulánico con clindamicina, incluyendo corticoides. En 10 niños se practicó estudio de imagen mediante tomografía axial (TC) y en nueve punción-aspiración mediante aguja fina (PAAF). Ante la confirmación de absceso, se efectuó drenaje en el 20,6 % de los casos. La estancia hospitalaria fue de 5,6 +/- 1,6 días. Se practicó amigdalectomía diferida en el 31 %, excepto en un caso que desarrolló un absceso parafaríngeo. La población infantil padece en la actualidad el 18,9 % de todos los casos de infección periamigdalina. Conclusiones Este incremento está probablemente relacionado con el tratamiento inapropiado de antibióticos en enfermedades respiratorias. El diagnóstico es clínico y a menudo la administración intravenosa de betalactámicos con clindamicina y una actitud expectante son resolutivos. La sospecha de absceso o la ausencia de mejoría clínica recomiendan realizar PAAF y/o TC y drenaje ante su confirmación. La amigdalectomía, normalmente diferida, debería indicarse sólo en casos de amigdalitis de repetición

Objective To evaluate the clinical and epidemiologic characteristics in children with peritonsillar infections. Patients and methods A longitudinal retrospective study was performed through a review of the clinical histories of patients attending the emergency unit in the previous 6 years. The variables gathered were age, sex, recurrent tonsillitis, previous upper airway infection, antibiotic administration, and therapeutic approach. Results Twenty-nine children were admitted, with a mean age of 7.4 +/- 1.6 years (boys 1.6:1). Twenty-seven percent had recurrent tonsillitis. At the visit, 57.8 % had an upper respiratory infection and 65 % were taking antibiotic treatment, especially macrolides. The treatment selected at our center consisted of the association of penicillin or amoxicillin-clavulanate acid with clindamycin, including corticosteroids. Ten children underwent computed tomography and nine underwent fine-needle aspiration. Drainage was performed in 20.6 % of confirmed abscesses. The mean length of hospital stay was 5.6 +/- 1.6 days. Delayed tonsillectomy was performed in 31 %, except in one patient who developed a parapharyngeal abscess. Currently, 18.9 % of all peritonsillar infections occur in the pediatric population. Conclusions The increase in these infections is probably related to inappropriate use of antibiotics in respiratory diseases. Diagnosis is clinical, and infections are often resolved by intravenous administration of Beta-lactams with clindamycin and an expectant attitude. When an abscess is suspected or there is no clinical improvement, fine-needle aspiration or computed tomography is warranted and drainage should be performed if an abscess is confirmed. Tonsillectomy, usually delayed, is only indicated in patients with recurrent tonsillitis

[Immunomediation or hyperviscosity in rapidly progressive sensorineural hearing loss. A therapeutic approach]. / Inmunomediación o hiperviscosidad en la hipoacusia neurosensorial rápidamente progresiva. Una aproximación terapéutica.

INTRODUCTION: To evaluate the therapeutic response and the rheologic and immunological characteristics in subjects bearing of rapidly progressive sensorineural hearing loss (RPSHL). PATIENTS AND METHODS: A comparative prospective study on three groups of damaged ears treated with piracetam (n=29), corticosteroids (n=32) and plabcebo (n=25). Hearing loss and recovery level, whole blood filterability (WBF) and a Western-blot (WB) to anticochlear antibodies were evaluated. RESULTS: Recovery average was 20,8 +/- 55,9% in the first group, with progressive of deafness in the rest (p<0,01). WB did not show differences among groups. The higher WBF at the end of therapy was detected on group 1 (20,36 +/- 2,54 Vs 18,42 +/- 3,42 microl/seg on group 3; p<0,05). Moreover, it impaired only on those treated with piracetam, with statistically significative differences over the other two groups. CONCLUSIONS: We detected alterations on WBF in patients with RPSHL that justify the use of rheoactive measures as a pathophysiological therapy.

[Changes on blood filterability in patients with fluctuant hearing loss]. / Variaciones en la filtrabilidad sanguínea en pacientes con hipoacusia fluctuante.

We developed a two year follow-up in thirteen subjects bearing of fluctuant sensorineural hearing loss measuring their blood filterability (BF) and making a correlation to appearance of deafness episodes. We could observe a decrease on BF in all patients when they felt a hearing loss. When they recovered the hearing level, BF increased too. The use of reoactive techniques to avoid these decreases on BF in fluctuant deafness could potentially prevent or improve them.

[Cormobidity of sensorineural hearing loss and other autoimmune diseases. Usefulness of laboratory tests]. / Estudio de comorbilidad de la hipoacusia neurosensorial y otras enfermedades de patogenia autoinmune. Utilidad de las pruebas de laboratorio.

OBJECTIVES: To value if the sensorineural hearing loss (SHL) in several autoimmune diseases (AD) is also secondary to immunomediation. PATIENTS AND METHODS: In 342 cases with SHL and any AD and 301 normoacoustic controls with AD a non-specific immunologic battery of tests and a Western-blot (WB) for anticochlear autoantibodies were developed, and cases with SHL were treated with deflazacort. RESULTS: Alterations in non-specific battery were similar between cases and controls. But a 12,5% of cases with SHL and a 1,6% of normoacoustic showed a positive WB (p<0,001). Steroid therapy improved hearing in 14,3% of cases. In them, sensitivity and specificity of non-specific battery were 78,4% and 75,5%, respectively, to predict response to therapy. These were 98,9% and 81,6% for WB. CONCLUSIONS: The SHL in cases with AD can be considered immunomediated in a discrete average, but the diagnostic efficiency of WB to predict an improvement after steroid therapy is high.

[Blood viscosity profile in rapidly progressive sensorineural hearing loss with positive Western-blot]. / Perfil de la viscosidad sanguínea en la hipoacusia rápidamente progresiva con Western-blot positivo.

OBJECTIVE: To value a possible association between disorders in blood viscosity of patients with rapidly progressive sensorineural hearing loss (RPSHL) of autoimmune origin. PATIENTS AND METHODS: We studied the viscoelastic properties of blood in 43 subjects bearing of RPSHL and a positive Western-blot for anticochlear antibodies: whole blood viscosity (WBV) at different shear rates and erythrocyte filterability (EF). These results were related to hearing loss initially detected and recovery average one year later from steroid therapy. RESULTS: Just WBV at 230 sec(-1) shear rate was significatively higher in cases than in controls (p < 0.01). Hearing recovery degree correlated in an statistically way to increased values of EF (p < 0.01). There was no relation between initial hearing loss level and any rheology parameter. CONCLUSIONS: Autoimmune RPSHL does not show a pathophysiology mechanism associated to blood hyperviscosity. So, rheoactive therapies as plasmapheresis warrant no clinical improvement.

[Near-total laryngectomy. Experience, complications and acoustic analysis]. / Laringuectomía casi total. Experiencia, complicaciones y análisis de voz.

OBJECTIVE: To investigate the oncological efficiency, voice and complications of Pearson's near-total laryngectomy for advanced laryngeal cancers (T3, T4). MATERIAL AND METHODS: A retrospective review of 23 cases of near-total laryngectomy (carried out in our Hospital in the last nine years) was undertaken. RESULTS: None of the cases developed laryngeal mucosal recurrences. The overall three and five years disease free survival were 91,3% and 86,9%. Mean phonation time was 51 days. A statistically significant results were observed in our voice analysis (words/minute, taking as a reference healthy people (Medivoz). The pharyngeal fistula was the most frequent complication (60,86%). CONCLUSIONS: The local control of cancer was similar to that expected with total laryngectomy. Near-total laryngectomy is a valid alternative for extended laryngeal and neighbouring cancers with an acceptable morbidity and success rate for voice preservation.

[Auditory requirement for group 2 vehicle driving licences. An update in accordance with valid legislation in Spain]. / Requerimiento auditivo en licencias de conducción de vehículos del Grupo 2. Actualización conforme a la legislación vigente en España.

INTRODUCTION: Hearing loss level admitted for acquisition of Group 2 driving licences is actually 35%, but this measurement is not standarized. METHODS: In 35 drivers with Group 2 licence bearing of hearing loss, it was measured in the usual way -considering threshold as an average-, and also in accordance with valid legislation, which considers deafness when hearing thresholds are under 25 dB in each tone. RESULTS: Binaural hearing loss average was 41.3+/-6.3% for the first model, and 30.7+/-10.2% for the second. There was a good correlation between the two models by mean of lineal regression (y=1.4785x-30.382; R2=0.8467). CONCLUSIONS: In Group 2 licences, hearing loss average must be standarized in its quantifyng technique, because there is a wide difference in the results, depending on the model used to measure. In our country there are rules and regulations about quantifying for disable people, valid for establishing deafness measurement patterns in vehicle driving too.

[Hearing level and intensive use of mobile phones]. / Nivel auditivo y uso intensivo de teléfonos móviles.

INTRODUCTION: Wide studies and substantial controversies build on utilization of actual mobile phones and appearance of systemic disorders or even tumours, but there is no knowledge about an eventual involvement on early hearing loss. PATIENTS AND METHODS: In a group of three hundred and twenty-three healthy and normoacoustic volunteers who were usual costumers of mobile phones an audiometric evaluation was made at the beginnig of its use and three years later, inquiring about the periods of time per day and year employed on direct contacts with phone. A healthy and normoacoustic control group of non users was studied too. RESULTS: Cases carried out 24.3 +/- 8.2 active contacts, reaching 50.4 +/- 27.8 days of mobile phone employment in three years. Audiometric curve was similar in cases and controls at the beginning of the study. After this follow-up, cases showed an increase on hearing threshold between 1 and 5 dB HL more than controls in speech tones (p<0.001). Moreover, there was a trend to correlate time of phone use to hearing impairment, but this finding did not result statistically significative. CONCLUSIONS: Frequent management of mobile phones in a middle period of time allows to detect a mild hearing loss, but the cause of this disorder keeps unclear.

[Hearing loss measurement. An equation for a rapid calculation]. / Medida de la pérdida auditiva. Una ecuación para su cálculo rápido.

Hearing loss must be easily calculated by mean of the rules of actual legislation on handicap. It is just necessary to know the hearing thresholds for 500, 1000, 2000 and 4000 Hz tones. Calculation of a linear regression equation allows to obtain quickly hearing loss average from these thresholds.

[Hearing loss associated to ulcerative colitis]. / Hipoacusia asociada a colitis ulcerosa.

OBJECTIVE: To value the eventual immunomediation in sensorineural hearing loss (SHL) on patients bearing of ulcerative colitis (UC). MATERIAL AND METHODS: In a group of forty-nine cases with a mean age of 41.6+/-9.3 years old we studied the hearing loss level, the disease activity index, the peripheral blood inflammation markers and the anticochlear antibodies by mean of Western-blot technique (WB). RESULTS: The 26.5% knew about their deafness, although SHL was detected in 59.1% of cases. The mean age of onset was 40.3+/-9.8 years. 48.9% showed a positive WB, always in 68-70 kDa molecular weight blots. Moreover, patients with positive WB showed more severe deafness, higher disease activity and more altered parameters, especially erythrosedimentation rate. CONCLUSIONS: Audiologic and peripheral blood findings observed allow us to establish a reasonable suspicion of an autoimmune or immunomediated pathway of hearing loss on UC.

[Blood viscosity modifications in patients with presbycusis]. / Alteraciones en la viscosidad sanguínea en pacientes con presbiacusia.

OBJECTIVE: [corrected] To evaluate the existence of blood viscosity alterations in presbyacusis as an eventual pathophysiological mechanism. MATERIAL AND METHODS: Nine 75 year-old subjects bearing of bilateral slowly progressive sensorineural deafness were considered to be studied on a yearly basis in a ten year folow-up period, evaluating the binaural hearing loss in speech tones (500, 1000, 2000 and 3000 Hz). Hemorheological profile on peripheral blood included total blood viscosity (BV) at different shear rates (SR), blood filterability (BF), erythrocyte deformability and aggregability (EA). RESULTS: There was a trend of all parameters towards hyperviscosity, with an increase at ten years of BV at high SR and EA at total stasis which were statistically significant. The level of deafness correlated significativelly to low values of BF and increases on BV at high SR. CONCLUSIONS: Presbyacustic patients do show hemorheological evidences that suggest a tendency towards hyperviscosity as a predisposing factor for hearing loss.

[Otologic determining factors on infra-red tympanic thermometry in children]. / Condicionantes otológicos en termometría timpánica con infrarrojos en niños.

OBJECTIVE: To evaluate the influence of different otoscopic findings on body thermometry in children using an infra-red tympanic thermometer. PATIENTS AND METHODS: Body temperature was measured on healthy right and left ear canals with Thermoscan systems. Moreover, it was determined on children with altered otoscopy, companng to normal contralateral ear. To assess its diagnostic fiability, accuracy ratios were calculated in different temperatures. RESULTS: Temperature measured bilaterally did not offer differences, and intra/interassay variation ratios were always less than 0.34%. Acute otitis externa increased tympanic thermometry a mean of 0.36 degrees C (p < 0.001), and cerumen and previously radical surgery decreased a mean of 0.62 and 0.53 degrees C, respectively (p < 0.001). CONCLUSIONS: The conditions mentioned before modify body thermometry if measured by infra-red tympanic thermometer. So, this system must be avoided in these circumstances. Otitis media, fluid in middle ear, tympanic perforation and ventilation tubes did not modify thermometric results.

[Anticochlear antibodies titles measured by Western-blot and hearing recovery level after corticoid therapy in patients with sudden deafness]. / Titulación de anticuerpos anticocleares mediante Western-bloty grado de recuperación auditiva tras corticoterapia en pacientes con sordera súbita.

OBJECTIVES: Detection of antichoclear antibodies in patients with sudden deafness (SD) ranges from five to forty one percent depending on authors. We tried to correlate the level of antibodies measured by Western-blot (WB) and hearing loss. PATIENTS AND METHODS: Forty nine subjects bearing of SD and a positive WB for bovine cochlear antigen. Hearing loss average was measured at the onset and after treatment with deflazacort 1 mg/kg per day by means of audiometry, and antibody titles were quantified in the diluted sera. RESULTS: Initial loss was 49.4+/-20.6%, and after corticotherapy it was 15.9+/-18.0%. There was no statistically significative correlation titles-hearing loss (y=0.1122x+30.613; R2=0.7552) nor titles-recovery (y=-0.0818x+8.,65; R2=0.3229). CONCLUSIONS: Although predictive capability for treatment response is accepted for WB, quantifying of the antibody titles in patients with SD does not allow to make a prognosis about the average hearing recovery.

[Upper dysphagia due to a chemotherapy resistant Burkitt's lymphoma in a lingual tonsil]. / Disfagia alta por linfoma de Burkitt de amígdala lingual resistente a quimioterapia.

The higher incidence of immunosuppressive status is increasing in the last years the diagnosis of tumours of unusual location and behaviour. We present the case of a HIV-seropositive 41 years-old woman, bearing of high dysphagia and pharyngolalic voice. The exploration showed a tumour emerging in lingual tonsil and spreading out to hypopharynx and larynx. No lymph nodes were observed. Its resistance to chemotherapy made necessary its surgical removal.