Reducción de la tasa de broncoaspiración con el test 2 volúmenes/3 texturas con pulsioximetría en una unidad de ictus / Lowering bronchoaspiration rate in an acute stroke unit by means of a 2 volume/3 texture dysphagia screening test with pulsioximetry

Introducción: En la fase aguda del ictus el 30% de los pacientes presentan disfagia, y de ellos, el 50% experimentarán broncoaspiración. Nuestro objetivo fue evaluar los resultados de mortalidad y broncoaspiración del test del agua comparado con el test 2 volúmenes/3 texturas controlado con pulsioximetría (2v/3t-P) en una unidad de ictus. Pacientes y métodos: Durante 5 años se analizaron de forma prospectiva y consecutiva todos los pacientes con infarto cerebral en la Unidad de Ictus. Del año 2008 al 2010 se utilizó el test del agua (grupo 0 o G0), y del 2011 al 2012, el test 2v/3t-P (grupo 1 o G1). Se recogieron las siguientes variables: demográficas, factores de riesgo vascular, gravedad neurológica con la escala NIHSS, subtipo etiológico según criterios TOAST, subtipo clínico según la clasificación Oxfordshire, prevalencia de disfagia, broncoaspiración y exitus. Resultados: Se analizaron 418 pacientes con infarto cerebral agudo (G0 = 275, G1 = 143). Se detectaron diferencias significativas entre ambos grupos en el porcentaje de pacientes con TACI (17% en G0 vs. 29% en G1, p = 0,005) y en la mediana de NIHSS (4 puntos en G0 vs. 7 puntos en G1, p = 0,003). Con el test 2v/3t-P se detectó un aumento no significativo en el porcentaje de disfagia (22% en G0 vs. 25% en G1, p = 0,4), una menor tasa de mortalidad (1,7% en G0 vs. 0,7% en G1, p = 0,3) y una reducción significativa de broncoaspiración (6,2% en G0 vs. 2,1% en G1, p = 0,05). Conclusiones: El nuevo test 2v/3t-P, comparado con el test del agua, mejoró significativamente los resultados de broncoaspiración en los pacientes con infarto cerebral agudo

Introduction: During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. Patients and methods. Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. Results: We examined 418 patients with acute stroke (G0 = 275, G1 = 143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P = .005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P = .003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P = .4), lower mortality (1.7% in G0 vs. 0.7% in G1, P = .3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P = .05). Conclusions: Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients

Lowering bronchoaspiration rate in an acute stroke unit by means of a 2 volume/3 texture dysphagia screening test with pulsioximetry. / Reducción de la tasa de broncoaspiración con el test 2 volúmenes/3 texturas con pulsioximetría en una unidad de ictus.

INTRODUCTION: During acute stroke, 30% of all patients present dysphagia and 50% of that subgroup will experience bronchoaspiration. Our aim was to compare mortality and bronchoaspiration rates associated with the water test compared to those associated with a 2 volume/3 texture test controlled with pulse oximetry (2v/3t-P test) in our stroke unit. PATIENTS AND METHODS: Over a 5-year period, we performed a prospective analysis of all consecutive acute ischaemic stroke patients hospitalised in the Stroke Unit. Dysphagia was evaluated using the water test between 2008 and 2010 (group 0 or G0), and the 2v/3t-P test (group 1 or G1) between 2011 and 2012. We analysed demographic data, vascular risk factors, neurological deficit on the NIHSS, aetiological subtype according to TOAST criteria, clinical subtype according to the Oxfordshire classification, prevalence of dysphagia, percentage of patients with bronchoaspiration, and mortality. RESULTS: We examined 418 patients with acute stroke (G0=275, G1=143). There were significant differences between the 2 groups regarding the percentage of patients with TACI (17% in G0 vs. 29% in G1, P=.005) and median NIHSS score (4 points in G0 vs. 7 points in G1, P=.003). Since adopting the new swallowing test, we detected a non-significant increase in the percentage of dysphagia (22% in G0 vs. 25% in G1, P=.4), lower mortality (1.7% in G0 vs. 0.7% in G1, P=.3) and a significant decrease in the bronchoaspiration rate (6.2% in G0 vs. 2.1% in G1, P=.05). CONCLUSIONS: Compared to the water test used for dysphagia screening, the new 2v/3t-P test lowered bronchoaspiration rates in acute stroke patients.

¿Está indicado el tratamiento tópico en las otitis que cursan con otorrea en el niño? Aportación terapéutica de ciprofloxacina tópico / Is topical treatment indicated in otitis that occurs with otorrhea in the child? Therapeutic contribution of topical ciprofloxacin

La otorrea es un síntoma no un diagnóstico presente en distintas entidades clínicas. Existen diversas e importantes razones para considerar el abordaje tópico como una terapia útil en el tratamiento de la otorrea en el niño. La bajas concentraciones con las que son eficaces los agentes farmacológicos administrados por vía tópica, así como el bajo grado de reacciones adversas unido al bajo riesgo de complicaciones sistemáticas, son premisas lo suficientemente válidas para considerar el tratamiento tópico como una alternativa o complemento terapéutico altamente eficaz en distintas situaciones clínicas que cursan con otorrea. Los tratamientos tópicos incluyen habitualmente agentes antimicrobianos. Hay evidencia de que los aminoglucósidos tópicos pueden causar ototoxicidad. Los antimicrobianos noaminoglucósidos, especialmente las fluoroquinolonas, están recomendadas cuando hay que acceder a oído medio. Ciprofloxacina tópica ha demostrado su elevada eficacia terapéutica en otitis externa, otorrea persistente post otitis media aguada, otitis media crónica simple, profilaxis pre-timpanostomía y otorrea a través de tubos de ventilación transtimpánicos, todas ellas patologías de elevada prevalencia en la edad pediátrica (AU)

Otorrhea is a symptom present in different clinical conditions and not a diagnosis. There are several and important reasons to consider topical treatment as a useful therapy in the treatment of otorrhea in the child. The low concentrations needed for the pharmacological agents administered topically to be effective and the low grade of adverse events together with low risk of systemic complications are sufficiently valid premises to consider topical treatment as a higher effective alternative or therapeutic complement in different clinical conditions that occur with otorrhea. Topical treatments generally include antimicrobial agents. There is evidence that the topical aminoglycosides may cause ototoxicity. Non-aminoglycoside antimicrobial agents, especially fluoroquinolones, are recommended when it is necessary to access the middle ear. Topical ciprofloxacin has demonstrated its elevated therapeutic efficacy in external otitis, persistent otorrhea, post acute otitis media, simple chronic otitis media, pre-tympanostomy prophylaxis and otorrhea through transtympanic ventilationtubes, diseases with elevated prevalence in the pediatric age (AU)

[Pharyngeal globe and pharyngo-laryngeal reflux]. / Globo faríngeo y reflujo faringo-laríngeo.

The globus sensation is one of the most frequent complaints in a basic ENT clinic. The etiology is still unknown, although some hypotheses have been suggested such as: psychological abnormalities, esophageal and cricopharyngeal muscle disfunction and the laryngopharyngeal reflux. Laryngopharyngeal reflux is the most frequent pathology related to the globus feeling. We've tried in this study to determine the incidence of laryngopharyngeal reflux in a group of 30 patients with globus feeling. We found 26.7% of these patients with an abnormal pH monitoring test.

Globo faríngeo y reflujo faringo-laríngeo / Pharyngeal globe and pharyngo-laryngeal reflux

El globo faríngeo es una de las patologías más frecuentes en las consultas otorrinolaringológicas básicas. Se han intentado determinar diferentes teorías que justifiquen la presencia de este síntoma, como una personalidad psicológicamente alterada, alteraciones en la motilidad esofágica, disfunciones del músculo cricofaríngeo y el reflujo faringolaríngeo. De todas ellas el reflujo faringo-laríngeo (RFL) es la que se encuentra con más frecuencia, aunque de forma variable. En este estudio se ha determinado la incidencia de RFL mediante pH-metría de 24 horas en un grupo de 30 pacientes diagnosticados de globo faríngeo. La incidencia de reflujo faringo-laríngeo ha sido del 26,7 por ciento de los pacientes (AU)

The globus sensation is one of the most frequent complaints in a basic ENT clinic. The etiology is still unknown, although some hypotheses have been suggested such as: psychological abnormalities, esophageal and cricopharyngeal muscle disfunction and the laryngopharyngeal reflux. Laryngopharyngeal reflux is the most frequent pathology related to the globus feeling. We've tried in this study to determine the incidence of laryngopharyngeal reflux in a group of 30 patients with globus feeling. We found 26.7% of these patients with an abnormal pH monitoring test (AU)