Prevalencia de hipofunción vestibular en el vértigo postural paroxístico benigno post traumatismo craneoencefálico / Prevalence of vestibular hypofunction in benign paroxysmal postural vertigo after head trauma

Introducción: El traumatismo craneoencefálico (TCE) puede generar vértigo, mareo e inestabilidad. Posibles causas otorrinolaringológicas son el vértigo postural paroxístico benigno (VPPB) que constituye el diagnóstico más frecuente, y la hipofunción vestibular. Objetivo: Describir la prevalencia de hipofunción vestibular en un grupo de pacientes con VPPB asociado a TCE. Material y Método: Estudio retrospectivo de pacientes con VPPB asociado a TCE que requirieron maniobra de reposición (MRP) entre los años 2017 y 2021. La información clínica, características clínico-demográficas, hallazgos en pruebas de función vestibular y número de MRP fueron evaluados. Resultados: Se incluyeron 48 pacientes con una edad promedio de 60,8 ± 16,5 años, siendo un 52% mujeres. La prevalencia de pacientes con paresia vestibular concomitante correspondió al 35,4%. Al comparar al grupo con y sin paresia se observó: (1) en el grupo con paresia fue, significativamente, más frecuente presentar contusión cerebral asociada, 47,1% vs 12,9%; (2) el sexo masculino fue, significativamente, más frecuente en el grupo con paresia, 70,59% vs 35,5%; (3) en ambos grupos, la mediana de MRP fue 1. Conclusión: La presencia de paresia vestibular en pacientes con VPPB secundario a TCE, no es un hallazgo infrecuente, en nuestro estudio, correspondió a un 35,4%, siendo este más frecuente en hombres. Adicionalmente, la contusión cerebral asociada es más frecuente en el grupo con paresia.

Introduction: Head trauma can generate vertigo, dizziness and instability. Possible otorhinolaryngologic causes are benign paroxysmal postural vertigo (BPPV), which is the most frequent diagnosis, and vestibular hypofunction. Aim: To describe the prevalence of vestibular hypofunction in a group of patients with BPPV associated with head trauma. We studied the clinical characteristics, vestibular function test findings and the number of (PRM). Material and Method: Retrospective study of patients with BPPV associated with head trauma who underwent particle repositioning maneuvers (PRM) during the years 2017 to 2021. Clinical characteristics, vestibular function test findings and the number of PRM were evaluated. Results: 48 patents were included. The mean age was 60.8 ± 16.5 years old, 52% were women. The prevalence of patients with concomitant vestibular paresis was 35.4%. When comparing the groups with and without paresis the following was observed: (1) associated brain contusions were significatively more frequent in the paresis group, 47.1% vs 12.9%; (2) male sex was significatively more frequent in the paresis group, 70.59% vs 35.5%; (3) in both groups, the median of needed PRM was 1. Conclusion: The presence of vestibular paresis in patients with BPPV secondary to head trauma is not an infrequent finding. In our study, its prevalence was 35.4%, being significatively more frequent in men. Also, associated brain contusions were significatively more frequent in the paresis group.

Development and Validation of a Laryngeal Microsurgery Simulation Training System for Otolaryngology Residents.

OBJECTIVE: This study aims to create a synthetic laryngeal microsurgery simulation model and training program; to assess its face, content, and construct validity; and to review the available phonomicrosurgery simulation models in the literature. STUDY DESIGN: Nonrandomly assigned control study. SETTING: Simulation training course for the otolaryngology residency program at Pontificia Universidad Católica de Chile. METHODS: Resident (postgraduate year 1 [PGY1]/PGY2) and expert groups were recruited. A laryngeal microsurgery synthetic model was developed. Nine tasks were designed and assessed through a set of programmed exercises with increasing difficulty, to fulfill 5 surgical competencies. Imperial College Surgical Assessment Device sensors applied to the participants' hands measured time and movements. The activities were video-recorded and blindly assessed by 2 laryngologists using a specific and global rating scale (SRS and GRS). A 5-point Likert survey assessing validity was completed by experts. RESULTS: Eighteen participants were recruited (14 residents and 4 experts). Experts performed significantly better than residents in the SRS (p = .003), and GRS (p = .004). Internal consistency was demonstrated for the SRS (α = .972, p < .001). Experts had a shorter execution time (p = .007), and path length with the right hand (p = .04). The left hand did not show significant differences. The survey assessing validity resulted in a median 36 out of 40 points score for face validity; and 43 out of 45 points score, for global content validity. The literature review revealed 20 available phonomicrosurgery simulation models, only 6 with construct validity. CONCLUSION: The face, content, and construct validity of the laryngeal microsurgery simulation training program were established. It could be replicated and incorporated into residents' curricula.

Benign Paroxysmal Positional Vertigo Secondary to Acute Unilateral Peripheral Vestibulopathy: Evaluation of Cardiovascular Risk Factors.

BACKGROUND: Lindsay-Hemenway syndrome was first described as an acute unilateral peripheral vestibulopathy followed by positional vertigo. A vascular etiology was proposed. An association between cardiovascular risk factors and benign paroxysmal positional vertigo secondary to acute unilateral peripheral vestibulopathy has been described with contradictory evidence. The study aimed to evaluate the prevalence of cardiovascular risk factors in patients with benign paroxysmal positional vertigo secondary to acute unilateral peripheral vestibulopathy and analyze differences in prior history of benign paroxysmal positional vertigo, affected semicircular canals, and response to repositioning maneuvers between patients with idiopathic benign paroxysmal positional vertigo and secondary to acute unilateral peripheral vestibulopathy. METHODS: We performed a retrospective, descriptive study of all cases of benign paroxysmal positional vertigo between January/2017 and June/2020, with or without a history of acute unilateral peripheral vestibulopathy within the previous year. Cases secondary to trauma or otoneurological causes and acute unilateral peripheral vestibulopathy without confirmatory tests and cases with auditory symptoms were excluded. RESULTS: In total, 242 cases were obtained; 158 idiopathic benign paroxysmal positional vertigo and 84 secondary to acute unilateral peripheral vestibulopathy. No statistically significant differences were found in relation to age: 61.2 ± 14.6 versus 62.4 ± 16.2 years (P=.55), sex: female 78.5% versus 73.8% (P=.41), presence of cardiovascular risk factors: 52.5% versus 54.8% (P=.67), prior history of benign paroxysmal positional vertigo: 22.2% versus 27.7% (P=.43), affected semicircular canals (P=.16) or number of repositioning maneuvers (P=.57). CONCLUSION: Associations between age, cardiovascular risk factors, and benign paroxysmal positional vertigo secondary to acute unilateral peripheral vestibulopathy have been described with conflicting evidence. This is the first study to evaluate cardiovascular risk factors specifically for Lindsay-Hemenway syndrome, and we did not observe any differences between idiopathic benign paroxysmal positional vertigo cases and those secondary to acute unilateral peripheral vestibulopathy.

Diagnóstico de otitis media con efusión en adultos / Diagnosis of otitis media with effusion in adults

La otitis media con efusión (OME) se define como la presencia de líquido en la cavidad del oído medio, sin signos ni síntomas de infección. Es una patología frecuente en niños, alcanzando una prevalencia del 14,8% en población de 4 a 16 años y su patogenia en este grupo se encuentra ampliamente estudiada. Sin embargo, en adultos su prevalencia es baja y, consecuentemente, su patogenia y mecanismos están menos dilucidados. El objetivo de esta revisión es describir la fisiopatología de la OME en adultos, describir sus etiologías y proponer un algoritmo de estudio diagnóstico adecuado.

Otitis media with effusion (OME), is defined as the presence of fluid in the middle ear, with no signs of acute infection. It is a frequent pathology in children, with a prevalence of 14.8% in the population between 4-16 years old, and its pathology has been widely studied in this group. However, its prevalence in adults is low; therefore, the pathology and mechanisms are less elucidated. The aim of this review is to describe the physio-pathology of the OME in adults, its etiology, and propose an algorithm for the proper diagnosis of this disease.