Esofagitis eosinofílica: una entidad patológica relevante para el otorrinolaringólogo / Eosinophilic esophagitis: A relevant entity for the otolaryngologist

La esofagitis eosinofílica (EE) es una entidad clínico patológica reconocida recientemente y con una prevalencia que va en aumento desde su descripción inicial. Su diagnóstico representa un reto para diferentes especialistas, entre los que tiene un rol destacado el otorrinolaringólogo. La sospecha clínica ante un paciente que presenta episodios recidivantes de impactación de alimentos no punzantes o ante un niño con trastornos de la alimentación y antecedentes de atopia constituyen el primer signo de alerta de una posible EE. El objetivo de esta revisión persigue destacar el papel de la EE en el diagnóstico diferencial de los pacientes con trastornos de la deglución, así como dar a conocer las manifestaciones clínicas que deben alertar al otorrinolaringólogo para proseguir la realización de las pruebas encaminadas al diagnóstico de esta enfermedad. La esofagoscopia transnasal, realizada por el otorrinolaringólogo en consulta, ayudará a disminuir el número de casos infradiagnosticados. Dado que gran parte de los pacientes afectos de trastornos de la deglución van a ser evaluados por el otorrinolaringólogo, se hace imprescindible el reconocimiento de la EE, así como el manejo diagnóstico-terapéutico por un equipo multidisciplinar en el que se involucren, además del otorrinolaringólogo, pediatras, digestólogos, alergólogos y patólogos familiarizados con la enfermedad. La identificación del alimento responsable de la inflamación del esófago y su eliminación de la dieta es la clave del tratamiento de este desorden inmunomediado (AU)

Eosinophilic esophagitis (EE) is a recently recognised pathologic entity whose prevalence has risen significantly since it was first described. Its diagnosis represents a challenge for different medical specialties, among which ENT specialists play an important role. Clinical suspicion in a patient with recurrent food impaction or a child with eating disorders and history of hypersensitivity constitutes the first warning sign of a possible EE. The purpose of this review is to highlight EE as a possible differential diagnosis in patients with deglutition disorders and describe the possible clinical symptoms that should alert the ENT specialist to perform appropriate diagnostic tests and procedures. The transnasal esophagoscopy, performed in-office by the ENT, is ideal for reducing possible underdiagnosed cases. Given the fact that an ENT specialist will evaluate a great many patients with deglutition disorders, it is paramount for possible EE cases to be suspected and recognised so that a correct multidisciplinary approach involving not only ENT specialists but also paediatricians, gastroenterologists, allergologists and pathologists can be established. Identifying the dietary component responsible for the esophageal inflammation and removing that food from the patient's diet is the key in the treatment of this immune-mediated disease (AU)

Audiometría con extensión en altas frecuencias (9.000-20.000 Hz). Utilidad en el diagnóstico audiológico / Extended high-frequency audiometry (9, 000-20, 000 hz). Usefulness in audiological diagnosis

La detección precoz y el tratamiento adecuado de la hipoacusia es fundamental para minimizar las consecuencias de la pérdida auditiva. Además de la audiometría convencional (125-8.000 Hz), disponemos de la audiometría con extensión en altas frecuencias (9.000 - 20.000 Hz), que puede ser de gran utilidad en el diagnóstico precoz de hipoacusia en ciertas patologías, como es el efecto ototóxico de los tratamientos quimioterápicos, la exposición a ruido o el mal entendimiento del lenguaje, especialmente en ambientes ruidosos. Aquí se presentan 11 casos clínicos en los que la audiometría con extensión en altas frecuencias ha ayudado en la detección precoz de la hipoacusia en diversas patologías, a pesar de tener una audiometría normal en frecuencias convencionales. Se pretende así destacar la importancia de la exploración audiométrica en altas frecuencias, con el fin de que se convierta en una herramienta habitual en la exploración audiológica (AU)

Early detection and appropriate treatment of hearing loss are essential to minimise the consequences of hearing loss. In addition to conventional audiometry (125-8,000 Hz), extended high-frequency audiometry (9,000-20,000 Hz) is available. This type of audiometry may be useful in early diagnosis of hearing loss in certain conditions, such as the ototoxic effect of cisplatin-based treatment, noise exposure or oral misunderstanding, especially in noisy environments. Eleven examples are shown in which extended high-frequency audiometry has been useful in early detection of hearing loss, despite the subject having a normal conventional audiometry. The goal of the present paper was to highlight the importance of the extended high-frequency audiometry examination for it to become a standard tool in routine audiological examinations (AU)

Eosinophilic esophagitis: A relevant entity for the otolaryngologist. / Esofagitis eosinofílica: una entidad patológica relevante para el otorrinolaringólogo.

Eosinophilic esophagitis (EE) is a recently recognised pathologic entity whose prevalence has risen significantly since it was first described. Its diagnosis represents a challenge for different medical specialties, among which ENT specialists play an important role. Clinical suspicion in a patient with recurrent food impaction or a child with eating disorders and history of hypersensitivity constitutes the first warning sign of a possible EE. The purpose of this review is to highlight EE as a possible differential diagnosis in patients with deglutition disorders and describe the possible clinical symptoms that should alert the ENT specialist to perform appropriate diagnostic tests and procedures. The transnasal esophagoscopy, performed in-office by the ENT, is ideal for reducing possible underdiagnosed cases. Given the fact that an ENT specialist will evaluate a great many patients with deglutition disorders, it is paramount for possible EE cases to be suspected and recognised so that a correct multidisciplinary approach involving not only ENT specialists but also paediatricians, gastroenterologists, allergologists and pathologists can be established. Identifying the dietary component responsible for the esophageal inflammation and removing that food from the patient's diet is the key in the treatment of this immune-mediated disease.

Extended high-frequency audiometry (9,000-20,000 Hz). Usefulness in audiological diagnosis.

Early detection and appropriate treatment of hearing loss are essential to minimise the consequences of hearing loss. In addition to conventional audiometry (125-8,000 Hz), extended high-frequency audiometry (9,000-20,000 Hz) is available. This type of audiometry may be useful in early diagnosis of hearing loss in certain conditions, such as the ototoxic effect of cisplatin-based treatment, noise exposure or oral misunderstanding, especially in noisy environments. Eleven examples are shown in which extended high-frequency audiometry has been useful in early detection of hearing loss, despite the subject having a normal conventional audiometry. The goal of the present paper was to highlight the importance of the extended high-frequency audiometry examination for it to become a standard tool in routine audiological examinations.

Revisión de las terapias biológicas en la enfermedad inmunomediada del oído interno / Review of the biologic agents used for immune-mediated inner ear disease

Introducción y objetivos: La enfermedad inmunomediada del oído interno (EIOI) es una de las escasas afecciones del oído interno que pueden revertirse con tratamiento médico. Este se basa en los corticoides, si bien el tratamiento prolongado con los mismos se asocia a serios efectos adversos, lo que ha propiciado el uso de otros fármacos o vías de administración como la intratimpánica. En este estudio se analiza el papel de las terapias biológicas en el tratamiento de la EIOI. Material y métodos: Se ha realizado una búsqueda sistemática en PUBMED de aquellos estudios que examinan la respuesta al tratamiento con distintos agentes biológicos en pacientes con EIOI. Se ha analizado los criterios de inclusión y exclusión de cada estudio, así como las características de la población estudiada, el tratamiento utilizado y, los criterios de respuesta y tasa de respuesta alcanzada. Resultados: Se identificaron 13 estudios relevantes. En 8 estudios se utilizó un inhibidor del TNFα (etanercept, infliximab, adalimumab), en 3 un antagonista de la IL-1 (anakinra) y en el resto se empleó el rituximab, un antagonista del receptor CD20 de los linfocitos B. En la mayoría de los estudios se logró una mejoría o estabilización de la audición en más del 70% de los pacientes tratados. Conclusiones: Las terapias biológicas pueden tener un papel en el tratamiento de los pacientes con EIOI, al menos en aquellos que responden mal a los corticoides o no se consigue su estabilización. Sin embargo, son necesarios más estudios controlados y aleatorizados para conocer su eficacia (AU)

Introduction and objectives: Immune-mediated inner ear disease (IMIED) is one of the few reversible forms of sensorineural hearing loss. Treatment is based on high-dose corticosteroids, although long-term therapy is associated with serious adverse effects; this has led to the use of other agents or different routes of administration such as transtympanic delivery. This study analyses the role of biological agents in IMIED management. Material and methods: We searched PUBMED for studies that examined the response to treatment with different biological agents in patients with IMIED. The following data were extracted from the selected studies and entered into a standardised database: exclusion and inclusion criteria, characteristics of the patients studied, treatment, outcome measures and response rates achieved. Results: Thirteen studies were included in this review. A TNF alpha inhibitor (etanercept, infliximab, adalimumab) was used in 8 studies, an IL-1 antagonist (anakinra) was used in 3 studies and rituximab, an antibody directed against the CD20 surface antigen on B lymphocytes, was evaluated in 2 studies. Most studies achieved a hearing improvement or stabilisation in more than 70% of treated patients. Conclusions: Biological agents can play a role in the management of patients with IMIED, at least in those patients who do not respond to conventional therapy or whose hearing is not stabilised. However, specially-designed randomised controlled clinical trials are needed to assess their effectiveness (AU)

Review of the biologic agents used for immune-mediated inner ear disease.

INTRODUCTION AND OBJECTIVES: Immune-mediated inner ear disease (IMIED) is one of the few reversible forms of sensorineural hearing loss. Treatment is based on high-dose corticosteroids, although long-term therapy is associated with serious adverse effects; this has led to the use of other agents or different routes of administration such as transtympanic delivery. This study analyses the role of biological agents in IMIED management. MATERIAL AND METHODS: We searched PUBMED for studies that examined the response to treatment with different biological agents in patients with IMIED. The following data were extracted from the selected studies and entered into a standardised database: exclusion and inclusion criteria, characteristics of the patients studied, treatment, outcome measures and response rates achieved. RESULTS: Thirteen studies were included in this review. A TNF alpha inhibitor (etanercept, infliximab, adalimumab) was used in 8 studies, an IL-1 antagonist (anakinra) was used in 3 studies and rituximab, an antibody directed against the CD20 surface antigen on B lymphocytes, was evaluated in 2 studies. Most studies achieved a hearing improvement or stabilisation in more than 70% of treated patients. CONCLUSIONS: Biological agents can play a role in the management of patients with IMIED, at least in those patients who do not respond to conventional therapy or whose hearing is not stabilised. However, specially-designed randomised controlled clinical trials are needed to assess their effectiveness.

[Designing a new tool for hearing exploration]. / Diseño de una nueva herramienta para la exploración auditiva.

INTRODUCTION: Many presbycusic patients have difficulty in understanding certain words. This could be justified because certain sounds in Spanish are more difficult to perceive, particularly the sounds with energy in the high frequencies. We propose to use a sentence as a tool to check this theory. MATERIALS AND METHOD: All the Spanish sounds were analyzed, measuring the degree of acoustic energy in all the frequencies. The conclusions drawn from the comparison of the results allowed the design of the tool that is proposed here. RESULTS: We established a gradient of perception difficulty, occlusive consonants being the least perceptible, followed by fricative, and finally all those segments with harmony and a clear formant structure. The Spanish sentence "Ana vio ese coche rojizo fino" is proposed as the tool for this study. This sentence has some as it comprises certain peculiarities that makes it particularly useful for this purpose. It will allow us to check whether understanding deteriorates as we move from beginning to end, helping evaluate the importance of high frequencies for intelligibility. CONCLUSIONS: A positive result could help in the design of amplification systems to improve speech intelligibility. In addition, the exploratory tool could allow neuro-acoustic exploration, useful in the central auditory pathology studies.

Diseño de una nueva herramienta para la exploración auditiva / Designing a new tool for hearing exploration

Introducción. Muchos pacientes presbiacúsicos presentan dificultad para entender ciertas palabras, hecho que podría estar justificado porque determinados sonidos en español presentan una dificultad mayor de perceptibilidad, en concreto los de energía en altas frecuencias. Se propone utilizar una oración como herramienta para comprobar la hipótesis de partida. Material y método. Se analizaron todos los sonidos del español, midiendo el grado de energía acústica que presenta cada una de las frecuencias. Las conclusiones extraídas de la comparación de sus resultados permitieron el diseño de la herramienta que aquí se propone. Resultados. Se establece una gradación de dificultad perceptiva, por lo que se puede decir que las oclusivas aparecen como los sonidos menos perceptibles, seguido de las fricativas y, finalmente, todos los segmentos que presentan armonicidad y una estructura formántica definida. Como herramienta para la práctica clínica, se propone la frase española «Ana vio ese coche rojizo fino», frase que cumple una serie de particularidades que la hacen especialmente útil para tal fin. Esta oración permitirá comprobar si la comprensión se va deteriorando a medida que se avanza desde la primera a la última de sus secciones, y así poder suponer que la capacidad para detectar auditivamente la presencia de energía reforzada en las altas frecuencias es indispensable para la inteligibilidad. Conclusiones. Un resultado positivo podría tener como consecuencia el diseño de sistemas de amplificación que mejoren la inteligibilidad de la palabra. Además, el hecho de tener una herramienta exploratoria podría permitir la exploración neuroacústica, de utilidad en el estudio de la enfermedad auditiva

Introduction. Many presbycusic patients have difficulty in understanding certain words. This could be justified because certain sounds in Spanish are more difficult to perceive, particularly the sounds with energy in the high frequencies. We propose to use a sentence as a tool to check this theory. Materials and method. All the Spanish sounds were analyzed, measuring the degree of acoustic energy in all the frequencies. The conclusions drawn from the comparison of the results allowed the design of the tool that is proposed here. Results. We established a gradient of perception difficulty, occlusive consonants being the least perceptible, followed by fricative, and finally all those segments with harmony and a clear formant structure. The Spanish sentence «Ana vio ese coche rojizo fino» is proposed as the tool for this study. This sentence has some as it comprises certain peculiarities that makes it particularly useful for this purpose. It will allow us to check whether understanding deteriorates as we move from beginning to end, helping evaluate the importance of high frequencies for intelligibility. Conclusions. A positive result could help in the design of amplification systems to improve speech intelligibility. In addition, the exploratory tool could allow neuro-acoustic exploration, useful in the central auditory pathology studies

Blood loss in endoscopic sinus surgery: assessment of variables.

OBJECTIVE: To identify the variables that influence blood loss in endoscopic sinus surgery performed under uniform conditions of preoperative topical vasoconstriction and surgical technique. STUDY DESIGN: Blind, nonrandomized, observational study. SETTING: One hundred thirty-eight consecutive patients who underwent endoscopic sinus surgery with the same technique in a university hospital over a 9-month period. METHODS: Pearson product-moment correlation was used for numerical variables and nonparametric tests for categorical variables: Mann-Whitney (comparison of two independent variables) and Kruskal-Wallis (comparison of more than two independent variables). MAIN OUTCOME MEASURES: Operative time, total blood loss, and blood loss per minute were correlated with blood loss markers: age, sex, surgeon, type and severity of illness, septoplasty, and anesthetic agents used. RESULTS: No correlation was found between age, sex, surgeon, and blood loss markers. Severe polyposis produced more blood loss than mild polyposis and sinusitis. Septoplasty showed an interesting inverse correlation with blood loss. Remifentanyl with fluorinated volatile agents was accompanied by less blood loss than other anesthetic agents. CONCLUSION: More blood loss occurred with more severe sinonasal pathology. Blood loss may be reduced by using remifentanyl with a fluorinated volatile agent and, possibly, preoperative infiltration with epinephrine.

Ageing evokes an intrinsic pro-apoptotic signalling pathway in rat cochlea.

CONCLUSIONS: These findings support the hypothesis that age-related apoptosis evokes an intrinsic pathway of pro-apoptotic signalling within the rat cochlea. OBJECTIVES: The aim of this study was to explore the effects of ageing on cochlear apoptosis in rats, as well as the different signalling pathways involved. MATERIALS AND METHODS: Female Sprague Dawley rats of different ages were used (mean age 7.72+/-1.93 months, n=100). Luciferase assays were used to determine the different caspase activities and ATP levels in rat cochlear protein extracts. Protein and gene expression was examined by Western blotting and real-time RT-PCR assays, respectively. RESULTS: Caspase-3/7 activity, as well as caspase-3 gene expression, were statistically higher in early-mature rats (EM, 276,139+/-13 669 RLUs (relative light units), p<0.001; and 390+/-50 arbitrary units, p=0.0017, respectively) or in aged-mature rats (AM, 371,020+/-26,457, p<0.0001; and 1510+/-90, p<0.0001, respectively) than younger rats (YR 147,129+/-8485 and 0.14+/-0.004, respectively). An increased caspase-9 activity with ageing was also observed (YR 49,932+/-2046 RLUs vs EM 260,890+/-5939, p<0.0001 or AM 118,241+/-12,423, p<0.0001). Caspase-8 activity was not affected significantly by age. Bax protein expression also increased by age (YR 38,200+/-1790 arbitrary units vs EM 76,549+/-5450, p<0.05), in contrast to Bcl-xL protein expression (YR 27,000+/-5000 arbitrary units vs EM 10,200+/-5000, p<0.005).