Feasibility of an Exoskeleton Armrest to Improve Ergonomics during Endoscopic Sinus and Skull Base Surgery.

OBJECTIVE: The main objective of this study was to develop and evaluate the feasibility and effectiveness of a novel exoskeleton system designed to provide ergonomic assistance to surgeons while preserving or improving the quality of endoscopic sinus and skull base surgical procedures. METHODS: To evaluate the functionality and ergonomic characteristics of the device, five experiments were conducted in different and increasingly realistic scenarios: silicone model of the nasal cavity, freshly frozen cadavers and finally in a real surgery. Each volunteer's task was recorded and timed. The National Aeronautics and Space Administration Task Load Index (NASA-TLX) rating scale was used to estimate the surgeons' workload while performing the tasks. RESULTS: Twenty-five volunteers took part in the experiments. Volunteers perceived more comfort and less fatigue and pain when using the armrest than when not using the device (3.3, SD 1.75 vs. 5.9 SD 1.49; p = 0.02). Participants found the device intuitive, comfortable, and improving accuracy and stability with endoscope use. CONCLUSION: A new system that provides ergonomic assistance to surgeons was tested in simulation surgery with acceptable usability. Initial results in terms of pain and fatigue reduction and efficiency were excellent, justifying further research into this technology. LEVEL OF EVIDENCE: NA Laryngoscope, 134:79-86, 2024.

The Role of Corticosteroid Nasal Irrigations in the Management of Chronic Rhinosinusitis: A State-of-the-Art Systematic Review.

Chronic rhinosinusitis (CRS) is a highly prevalent condition. CRS is usually managed with intranasal corticosteroids, useful both before as well as after endoscopic sinus surgery (ESS). However, the greatest drawback of these low-volume sprays is the inadequate delivery into the paranasal sinuses, even after ESS. Recent studies have shown that high-volume steroid nasal rinse (HSNR) has a significantly better penetration of the paranasal sinuses. The purpose of this state-of-the-art review is to systematically overview the current literature about the role of nasal rinses with steroids in CRS. Four authors examined four databases (Embase, Pubmed, Scielo, Cochrane). This review identified 23 studies answering 5 research questions. It included 1182 participants, 722 cases, and 460 controls. Available evidence suggests a potential positive effect of HSNR, which seems to be higher in CRS with nasal polyps. More well-designed studies are needed in order to obtain solid conclusions. The evidence is solid regarding the safety of this treatment modality in the short and long-term. We expect that this lack of severe negative effects will facilitate the acceptance of this treatment modality and the development of future studies.

Cirugía endoscópica endonasal durante la pandemia COVID-19: protocolo de actuación / Endoscopic endonasal surgery during COVID-19 pandemic: Management guideline

La actual pandemia por coronavirus SARS-CoV-2 está planteando una serie de desafíos al modo en que ejercemos la actividad médica y quirúrgica. En concreto, dentro de la neurocirugía se ha visto que los abordajes endoscópicos endonasales suponen un elevado riesgo de contagio para el personal sanitario que interviene en la misma, por lo que, inicialmente, la recomendación fue evitar dichas cirugías. Dado que la pandemia se ha extendido en el tiempo y desconocemos cuándo se podrá controlar, se deben proponer nuevas soluciones para continuar con la realización de dichos abordajes de manera segura. Ante la falta de protocolos establecidos, planteamos el siguiente, en el que se establecen, de modo conciso, las medidas a tomar tanto en cirugía urgente como programada, además de la descripción de un nuevo dispositivo de protección-aspirado (Maskpirator) AU)

Current SARS-CoV-2 coronavirus pandemic is challenging medical and surgical activities. Specifically, within neurosurgery, endoscopic endonasal approaches pose a high risk of contagion for healthcare personnel involved in it. Initially, the recommendation was to avoid such surgeries. However, the pandemic has dragged on and new solutions must be proposed to continue carrying out these approaches safely. Given the lack of established protocols, we propose the following one, which concisely establishes the measures to be taken in both urgent and scheduled surgery. In addition, a new protecti (AU)n-aspiration device (Maskpirator) is described.

A rare case of a secondary pituitary abscess arising in a craniopharyngioma with atypical presentation and clinical course.

Pituitary abscesses are very uncommon. They are divided into primary, arising within a healthy gland, and secondary, observed with an underlying pre-existing lesion. Here we present the eighth case reported of a secondary abscess within a craniopharyngioma. A 59-year-old-woman presented with a 3-week history of headache, and fever. Physical examination was unremarkable. An Magnetic Resonance Imaging (MRI) showed a pituitary lesion suggestive of a chronic inflammatory process. She was diagnosed with lymphocytic meningitis with hypophysitis and she was treated with corticosteroids. Two months later she presented with headache and fever again. Control MRI showed enlargement of the pituitary lesion. Therefore, a transsphenoidal biopsy was performed. During the procedure, purulent material was released. Histological study demonstrated a craniopharyngioma and meningeal inflammation. Empiric antibiotics were started. Three months post-operatively, a follow-up MRI showed a suspect minimal residual mass. Secondary pituitary abscesses are rare. The key to successful management is a high index of suspicion. Transsphenoidal surgical evacuation plus antibiotics is the mainstay of treatment. Although most symptoms resolve, endocrinopathies improve only rarely.

[Endoscopic endonasal surgery during COVID-19 pandemic: Management guideline]. / Cirugía endoscópica endonasal durante la pandemia COVID-19: protocolo de actuación.

Current SARS-CoV-2 coronavirus pandemic is challenging medical and surgical activities. Specifically, within neurosurgery, endoscopic endonasal approaches pose a high risk of contagion for healthcare personnel involved in it. Initially, the recommendation was to avoid such surgeries. However, the pandemic has dragged on and new solutions must be proposed to continue carrying out these approaches safely. Given the lack of established protocols, we propose the following one, which concisely establishes the measures to be taken in both urgent and scheduled surgery. In addition, a new protection-aspiration device (Maskpirator) is described.

Endoscopic endonasal surgery during COVID-19 pandemic: Management guideline.

Current SARS-CoV-2 coronavirus pandemic is challenging medical and surgical activities. Specifically, within neurosurgery, endoscopic endonasal approaches pose a high risk of contagion for healthcare personnel involved in it. Initially, the recommendation was to avoid such surgeries. However, the pandemic has dragged on and new solutions must be proposed to continue carrying out these approaches safely. Given the lack of established protocols, we propose the following one, which concisely establishes the measures to be taken in both urgent and scheduled surgery. In addition, a new protection-aspiration device (Maskpirator) is described.

Subjective evaluation of smell and taste dysfunction in patients with mild COVID-19 in Spain.

BACKGROUND: Has been described the loss of smell and taste as onset symptoms in SARS-CoV-2. The objective of this study was to investigate the prevalence in Spain. METHODS: Prospective study of COVID-19 confirmed patients through RT-PCR in Spain. Patients completed olfactory and gustatory questionnaires. RESULTS: A total of 1043 patients with mild COVID-19 disease. The mean age was 39 ±â€¯12 years. 826 patients (79.2%) described smell disorder, 662 (63.4%) as a total loss and 164 (15.7%) partial. 718 patients (68.8%) noticed some grade of taste dysfunction. There was a significant association between both disorders (p < 0.001). The olfactory dysfunction was the first symptom in 17.1%. The sQOD-NS scores were significantly lower in patients with a total loss compare to normosmic or hyposmic individuals (p = 0.001). Female were significantly more affected by olfactory and gustatory dysfunctions (p < 0.001). The early olfactory recover in 462 clinically cured patients was 315 (68.2%), during the first 4 weeks. CONCLUSION: The sudden onset smell and/or taste dysfunction should be considered highly suspicious for COVID-19 infection.

ANTECEDENTES Y OBJETIVO: En la infección por SARS-CoV-2 la pérdida repentina del olfato y/o gusto han sido descritas como síntomas iniciales. El objetivo principal de este estudio es conocer la prevalencia de estos síntomas en España. MATERIALES Y MÉTODOS: Estudio prospectivo de pacientes con COVID-19 confirmado mediante RT-PCR en España. Se utilizaron los cuestionarios traducidos y validados. RESULTADOS: Un total de 1043 pacientes COVID-19 leve. Edad media de 39 ±â€¯12 años. 826 pacientes (79,2%) refirieron algún grado de alteración del olfato, 662 (63,4%) pérdida total y 164 (15,7%) parcial. 718 pacientes (68,8%) notaron alteración del gusto. Hubo una asociación significativa entre ambos trastornos (p < 0,001). La disfunción olfatoria fue el síntoma inicial en el 17,1%. Las puntuaciones del sQOD-NS fueron significativamente menores en pacientes con una alteración total. Ambas alteraciones fueron proporcionalmente mayores en las mujeres (p < 0,001). De 462 pacientes clínicamente curados 315 (68,2%) recuperaron el olfato dentro de las primeras 4 semanas. CONCLUSIONES: La alteración repentina del olfato y el gusto debería ser reconocida como un síntoma de alarma de posible infección por COVID-19.

A rare case of a secondary pituitary abscess arising in a craniopharyngioma with atypical presentation and clinical course.

Pituitary abscesses are very uncommon. They are divided into primary, arising within a healthy gland, and secondary, observed with an underlying pre-existing lesion. Here we present the eighth case reported of a secondary abscess within a craniopharyngioma. A 59-year-old-woman presented with a 3-week history of headache, and fever. Physical examination was unremarkable. An Magnetic Resonance Imaging (MRI) showed a pituitary lesion suggestive of a chronic inflammatory process. She was diagnosed with lymphocytic meningitis with hypophysitis and she was treated with corticosteroids. Two months later she presented with headache and fever again. Control MRI showed enlargement of the pituitary lesion. Therefore, a transsphenoidal biopsy was performed. During the procedure, purulent material was released. Histological study demonstrated a craniopharyngioma and meningeal inflammation. Empiric antibiotics were started. Three months post-operatively, a follow-up MRI showed a suspect minimal residual mass. Secondary pituitary abscesses are rare. The key to successful management is a high index of suspicion. Transsphenoidal surgical evacuation plus antibiotics is the mainstay of treatment. Although most symptoms resolve, endocrinopathies improve only rarely.

Evaluación subjetiva de las alteraciones del olfato y del gusto en pacientes con afectación leve por COVID-19 en España / Subjective evaluation of smell and taste dysfunction in patients with mild COVID-19 in Spain

Antecedentes y objetivo: En la infección por SARS-CoV-2 la pérdida repentina del olfato y/o gusto han sido descritas como síntomas iniciales. El objetivo principal de este estudio es conocer la prevalencia de estos síntomas en España.Materiales y métodosEstudio prospectivo de pacientes con COVID-19 confirmado mediante RT-PCR en España. Se utilizaron los cuestionarios traducidos y validados.ResultadosUn total de 1043 pacientes con COVID-19 leve. Edad media de 39±12 años. De ellos 826 pacientes (79,2%) refirieron algún grado de alteración del olfato, 662 (63,4%) pérdida total y 164 (15,7%) parcial. Por otra parte 718 pacientes (68,8%) notaron alteración del gusto. Hubo una asociación significativa entre ambos trastornos (p<0,001). La disfunción olfatoria fue el síntoma inicial en el 17,1%. Las puntuaciones del sQOD-NS fueron significativamente menores en pacientes con una alteración total. Ambas alteraciones fueron proporcionalmente mayores en las mujeres (p<0,001). De 462 pacientes clínicamente curados 315 (68,2%) recuperaron el olfato dentro de las primeras 4 semanas.ConclusionesLa alteración repentina del olfato y el gusto debería ser reconocida como un síntoma de alarma de posible infección por COVID-19. (AU)

Background: Has been described the loss of smell and taste as onset symptoms in SARS-CoV-2. The objective of this study was to investigate the prevalence in Spain.MethodsProspective study of COVID-19 confirmed patients through RT-PCR in Spain. Patients completed olfactory and gustatory questionnaires.ResultsA total of 1043 patients with mild COVID-19 disease. The mean age was 39±12 years. 826 patients (79.2%) described smell disorder, 662 (63.4%) as a total loss and 164 (15.7%) partial. 718 patients (68.8%) noticed some grade of taste dysfunction. There was a significant association between both disorders (p<.001). The olfactory dysfunction was the first symptom in 17.1%. The sQOD-NS scores were significantly lower in patients with a total loss compare to normosmic or hyposmic individuals (p=.001). Female were significantly more affected by olfactory and gustatory dysfunctions (p<.001). The early olfactory recover in 462 clinically cured patients was 315 (68.2%), during the first 4 weeks.ConclusionThe sudden onset smell and/or taste dysfunction should be considered highly suspicious for COVID-19 infection. (AU)

[Subjective evaluation of smell and taste dysfunction in patients with mild COVID-19 in Spain]. / Evaluación subjetiva de las alteraciones del olfato y del gusto en pacientes con afectación leve por COVID-19 en España.

BACKGROUND: Has been described the loss of smell and taste as onset symptoms in SARS-CoV-2. The objective of this study was to investigate the prevalence in Spain. METHODS: Prospective study of COVID-19 confirmed patients through RT-PCR in Spain. Patients completed olfactory and gustatory questionnaires. RESULTS: A total of 1043 patients with mild COVID-19 disease. The mean age was 39±12 years. 826 patients (79.2%) described smell disorder, 662 (63.4%) as a total loss and 164 (15.7%) partial. 718 patients (68.8%) noticed some grade of taste dysfunction. There was a significant association between both disorders (p<.001). The olfactory dysfunction was the first symptom in 17.1%. The sQOD-NS scores were significantly lower in patients with a total loss compare to normosmic or hyposmic individuals (p=.001). Female were significantly more affected by olfactory and gustatory dysfunctions (p<.001). The early olfactory recover in 462 clinically cured patients was 315 (68.2%), during the first 4 weeks. CONCLUSION: The sudden onset smell and/or taste dysfunction should be considered highly suspicious for COVID-19 infection.

A novel aerosolisation mitigation device for endoscopic sinus and skull base surgery in the COVID-19 era.

PURPOSE: To provide a novel solution to reduce aerosol exposure in the operating room during endoscopic sinus and skull base procedures in the COVID-19 era. METHODS: We have designed a 3D printable midfacial mask that partially seals the nose, while allowing instrumentation during endoscopic transnasal surgery. The mask when connected to a vacuum system creates a constant negative pressure inside it, sucking out aerosols and gases generated during surgical procedures. Its effectiveness was tested using vapour exhalations by a human volunteer and drilling bone in a head model. The physical barrier effect was measured using fluorescein atomization in a head model. RESULTS: The pressure and airflow measured remained negative inside it in all the different situations tested. The mask was capable of completely evacuating human adult exhalation, and was more effective than the hand suction instrument. However, it was as effective as hand suction instrument at preventing aerosol spread from bone drilling. The physical barrier effect achieved a 72% reduction in the splatter created from the fluorescein atomization. CONCLUSIONS: The mask effectively prevented the spread of aerosols and reduced droplet spread during simulated transnasal endoscopic skull base surgery in laboratory conditions. This device has potential benefits in protecting surgical personnel against airborne transmission of COVID-19 and could be useful in reducing chronic exposure to the hazard of surgical smoke.

In-office endoscopic nasal polypectomy: prospective analysis of patient tolerability and efficacy.

PURPOSE: In-office rhinologic procedures have become popularised in the last decade, especially in North America. Endoscopic nasal polypectomy under local anaesthesia offers instant relief in selected patients with obstructive chronic rhinosinusitis with nasal polyps. We aimed to analyse patient tolerability during the procedure while measuring its effectiveness. METHODS: A prospective study of patients who underwent in-office microdebrider-assisted polypectomy under local anaesthetic from September 2018 to November 2019 in a Spanish tertiary hospital was performed. The tolerability was measured by monitoring vital signs during the procedure and using a visual analogue scale posteriorly. The effectiveness was calculated through patient-reported outcomes (SNOT-22) and endoscopic evaluation 1 and 6 months follow-up. RESULTS: Forty-four patients were included, with a mean age of 60.7 years. The mean visual analogue scale score was 2.76 out of 10 points. Vital signs were steady overall, with a statistically significant reduction (p < 0.001) in systolic pressure during the procedure. Presyncope and epistaxis were among the few mild complications. However, we registered one major complication that required intensive care admission. There was a 64% reduction in the SNOT-22 score in the first month, with a maintained effect after 6 months. Patients with asthma and a higher polyp load were the subgroups that required more time to achieve significant improvement. CONCLUSIONS: In-office polypectomy is a very effective technique that alleviates obstructive symptoms in patients with nasal polyposis, and it is generally safe and well tolerated when performed by an expert. However, rhinologists must be aware of potentially severe complications.

3D-printable headlight face shield adapter. Personal protective equipment in the COVID-19 era.

The coronavirus SARS-CoV-2 (COVID19) pandemic has pushed health workers to find creative solutions to a global shortage of personal protection equipment (PPE). 3D-printing technology is having an essential role during the pandemic providing solutions for this problem, for instance, modifying full-face snorkel masks or creating low-cost face shields to use as PPE (Ishack and Lipner, 2020 [1]). Otolaryngologists are at increased occupational risk to COVID19 infection due to the exposure to respiratory droplets and aerosols, especially during the routine nose and mouth examinations where coughing and sneezing happen regularly (Rna et al., 2017 [2]; Tysome and Bhutta, 2020 [3]). The use of a headlight is essential during these examinations. However, to our knowledge, none of the commercially available or 3D-printable face shields are compatible with a headlight. Hence, using a face shield and a headlight at the same time can be very uncomfortable and sometimes impossible. To solve this problem, we have designed a 3D-printable adapter for medical headlights, which can hold a transparent sheet to create a face shield as an effective barrier protection that can be used comfortably with the headlight. The adapter can be printed in different materials with the most commonly used nowadays being the cost-efficient PLA (Polylactic Acid) used for this prototype. The resulting piece weighs only 7 g and has an estimated cost of $0.15 USD. The transparent sheets, typically made from polyester and used for laser printing, can be purchased in any office material store with a standard price of 0.4 USD per unit. After use, the transparent sheet can be easily removed. We trialed the adapter in 7 different headlights. All of these headlights accommodated the printed blocks extremely well. The headlights were used in many different settings, including the ENT clinic, the operating room, the emergency room, the ENT ward and the COVID19 intensive care unit (ICU) for a two weeks period. All doctors using the headlight felt they were fully protected from respiratory droplets, blood, sputum and other fluids. The face shield with the headlight has been found very useful for treating epistaxis, changing tracheostomy cannulas and during routine nasal and oral examinations. The headlight face shield adapter was designed to solve a specific problem among the ENT community; however other specialist can find it useful as well. Nonetheless, manufacturers should take care of specifics problems like this and provide commercially available products to protect the ENT workforce in this new era.

The Effect of Reference Electrode Position in Cochlear Implants.

OBJECTIVE: This study aims to evaluate the increase in power of cochlear implants (CI) as the reference electrode (RE) position changes. Patients in whom it is necessary to use the full power of the device to achieve the desired stimulation levels, this strategy will ensure that stimulation capability is maximized. MATERIALS AND METHODS: The variability in RE placement in the temporal bone has a measurable effect on the electrical current, impedance, and power consumption, and if the electrode position has a functional effect on the stimulation intensity. The following three approaches were used: 1) classical circuit analysis, 2) 2-dimensional numerical simulations, and 3) real temporal bone measurements using a purpose-made CI. RESULTS: The three approaches demonstrate a significant decrease in the current intensity and electrical resistance for distances that are closer to the intra-cochlear electrode. The results also demonstrate that to maintain a constant current, shorter distances require 33% less power. CONCLUSION: Reference electrode position during surgery can make significant differences in CI power consumption and threshold intensity, which allows a more powerful stimulation in complicated patients (i.e., those with otosclerosis). This study presents an attractive perspective to surgeons, as it shows a way to decrease consumption that might result in a longer battery life or more power to be devoted to coding strategy performance.

Beneficios comunicativos de la implantación coclear bilateral. Estudio retrospectivo en niños de 12 años / Communication benefits of bilateral cochlear implantation. Retrospective study in 12-year-old children

Introducción y objetivos: Algunos estudios sugieren que la implantación coclear (IC) simultánea o secuencial en un corto periodo de tiempo aporta beneficios adicionales. Existe controversia acerca de la existencia de una edad límite a partir de la cual la segunda implantación aporta un beneficio menor en la adquisición de habilidades comunicativas. Los objetivos de nuestro estudio consisten en corroborar que la implantación coclear secuencial aporta beneficios sobre la unilateral, y estudiar si existen a los 12 años diferencias significativas según la edad en el momento de la segunda implantación. Métodos: Se trata de un estudio observacional descriptivo sobre una población de 12 años portadores de implante coclear (n = 69). Para evaluar los beneficios audiológicos se llevó a cabo una audiometría tonal liminar y un test de discriminación verbal a campo libre (bisílabos, frases cotidianas en contexto abierto, con y sin ruido). Resultados: Los resultados en términos de discriminación verbal fueron mejores en los pacientes implantados antes de los 2 años de edad, sin embargo no existen diferencias estadísticamente significativas (p > 0,5). Los usuarios de IC bilateral implantados antes de los 2 años y con un periodo entre interimplante inferior a 4 años muestran mejores porcentajes de discriminación verbal (p < 0,05). Conclusiones: La implantación coclear precoz y con un corto periodo interimplante demuestra en nuestra muestra proveer a los pacientes beneficios significativos en términos de inteligibilidad. Parece haber una edad y un periodo interimplante concreto a partir de la cual se reduce el beneficio auditivo sobre el primer implante (AU)

Introduction and objectives: Some studies suggest that simultaneous or sequential cochlear implantation in a short period of time offers additional benefits. There is controversy regarding the existence of an age limit after which a second implantation offers less benefit for the acquisition of communication skills. The objectives of this study were to confirm that sequential cochlear implantation offers benefits compared to unilateral implantation and to study whether, at 12 years of age, there are significant differences regarding the age at the time of the second implantation. Methods: Descriptive and observational study of a population of 12-year-old children carrying cochlear implants (n=69). A liminal pure tone audiometry and an open-field verbal discrimination test (disyllables, common phrases in an open context, with and without noise) were conducted to evaluate audiological benefits. Results: Verbal discrimination results were better among patients who had been implanted before the age of 2 years, although the differences were not statistically significant (P>0 . 5). Children who had received bilateral cochlear implants before the age of 2 years and with a period less than 4 years between both implants presented better verbal discrimination percentages (P<0 . 05). Conclusions: In our sample, early cochlear implantation with a short period between both implants provided significant benefits regarding intelligibility. There seem to be a specific age and interimplant period, after which the auditory benefit on the first implant becomes reduced (AU)

Communication benefits of bilateral cochlear implantation. Retrospective study in 12-year-old children.

INTRODUCTION AND OBJECTIVES: Some studies suggest that simultaneous or sequential cochlear implantation in a short period of time offers additional benefits. There is controversy regarding the existence of an age limit after which a second implantation offers less benefit for the acquisition of communication skills. The objectives of this study were to confirm that sequential cochlear implantation offers benefits compared to unilateral implantation and to study whether, at 12 years of age, there are significant differences regarding the age at the time of the second implantation. METHODS: Descriptive and observational study of a population of 12-year-old children carrying cochlear implants (n=69). A liminal pure tone audiometry and an open-field verbal discrimination test (disyllables, common phrases in an open context, with and without noise) were conducted to evaluate audiological benefits. RESULTS: Verbal discrimination results were better among patients who had been implanted before the age of 2 years, although the differences were not statistically significant (P>.5). Children who had received bilateral cochlear implants before the age of 2 years and with a period less than 4 years between both implants presented better verbal discrimination percentages (P<.05). CONCLUSIONS: In our sample, early cochlear implantation with a short period between both implants provided significant benefits regarding intelligibility. There seem to be a specific age and interimplant period, after which the auditory benefit on the first implant becomes reduced.