Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document.

INTRODUCTION: Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. OBJECTIVES: The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. MATERIAL AND METHODS: Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. RESULTS: We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. CONCLUSIONS: We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.

Impact of the COVID-19 pandemic on the training of otorhinolaryngology residents.

BACKGROUND AND OBJECTIVES: Training in surgical specialties has declined during the COVID-19 pandemic. A study was carried out to further analyze the impact of the COVID-19 pandemic on specific aspects of clinical, training, and research activities performed by the otolaryngology residents in Spain. METHODS: A cross-sectional qualitative study was conducted during the last two weeks of February 2021. The study consisted of an online survey taken by otolaryngology residents who had undertaken one-year continuing training from February 15, 2020, to February 15, 2021, and consisted of 26 questions exploring the impact of the COVID-19 on the health of the ENT residents and training activities. Categorical variables were reported as frequency and percentage. When indicated, Pearson's Chi-square test (χ2) with Yates's correction and Pearson's correlation coefficient (r) were used. RESULTS: 143 completed surveys were received from 264 Residents (54.17%). 36 residents (25.2%) have suffered from the disease due to SARS-CoV-2. Most of them only developed mild symptoms (86.1%), with 3 requiring hospitalisation (8.3%). The origin of infection was unknown in all reported cases and the need for confinement was principally due to either attending an asymptomatic patient in 9 cases (6.3%) or to being supposedly in close contact with an asymptomatic person in 22 (15.4%). 60.1% of the residents surveyed reported having lost more than 6 months of their training period, and in 18.8% of cases, it was as high as 10 and 12 months. There has been a reduction of more than 75% of what was planned in surgical training (p<0.05) of tympanoplasty, mastoidectomy, stapedectomy, cochlear implants, endoscopic sinonasal and anterior skull base surgery, septoplasty and turbinoplasty. CONCLUSIONS: The decline in ENT activity and residents having to assist in other COVID-19 units during the most critical moments of the pandemic, has caused the main reduction in their training capacity. Contagion mainly occurred through contact with asymptomatic carriers during patient care and through supposedly close contact with asymptomatic carriers. Virtual activities have been widely accepted, but they have not completely replaced all residents' training needs. Measures should be implemented to recover lost training, especially surgical practical learning in otology and rhinology.

Impacto de la pandemia COVID-19 en la formación de los residentes de otorrinolaringología / Impact of the COVID-19 pandemic on the training of otorhinolaryngology residents

Antecedentes y objetivosLa pandemia COVID-19 ha alterado todas las actividades sanitarias, entre ellas la formación especializada de los residentes. Se llevó a cabo un estudio para analizar en profundidad el impacto de la pandemia COVID-19 en aspectos específicos de las actividades clínicas, formativas e investigadoras que realizan los residentes de otorrinolaringología (ORL) en España durante un año completo de formación.MétodosSe realizó un estudio cualitativo transversal durante las últimas dos semanas de febrero de 2021. El estudio consistió en una encuesta en línea realizada por residentes de ORL que habían realizado un año continuado de formación desde el 15 de febrero de 2020 al 15 de febrero de 2021 y consistió en 26 preguntas que exploraban el impacto del COVID-19 en la salud de los residentes de ORL, en su dedicación laboral y en las actividades de formación. Las variables categóricas se informaron como frecuencia y porcentaje. Cuando se indicó, se utilizó la prueba chi-cuadrado de Pearson con la corrección de Yates y el coeficiente de correlación de Pearson (r).ResultadosSe recibieron 143 encuestas cumplimentadas de 264 residentes (54,17%). Treinta y seis residentes (25,2%) habían padecido la enfermedad por SARS-CoV-2. La mayoría de ellos solo desarrollaron síntomas leves (86,1%) y 3 requirieron hospitalización (8,3%). Los residentes encuestados que resultaron positivos para SARS-CoV-2 no fueron capaces de identificar la fuente de su contagio y la necesidad de confinamiento se debió principalmente a la atención de un paciente asintomático en 9 casos (6,3%) o al contacto estrecho con un asintomático en situaciones no identificadas distintas de la atención sanitaria en 22 (15,4%). El 60,1% de los residentes encuestados reportaron haber perdido más de 6meses de su período de formación, y en el 18,8% de los casos llegaron a 10 y 12meses. (AU)

Background and objectivesTraining in surgical specialties has declined during the COVID-19 pandemic. A study was carried out to further analyze the impact of the COVID-19 pandemic on specific aspects of clinical, training, and research activities performed by the otolaryngology residents in Spain.MethodsA cross-sectional qualitative study was conducted during the last two weeks of February 2021. The study consisted of an online survey taken by otolaryngology residents who had undertaken one-year continuing training from February 15, 2020, to February 15, 2021, and consisted of 26 questions exploring the impact of the COVID-19 on the health of the ENT residents and training activities. Categorical variables were reported as frequency and percentage. When indicated, Pearsońs Chi-square test (χ2) with Yates's correction and Pearson's correlation coefficient (r) were used.Results143 completed surveys were received from 264 residents (54.17%). 36 residents (25.2%) have suffered from the disease due to SARS-CoV-2. Most of them only developed mild symptoms (86.1%), with 3 requiring hospitalization (8.3%). The origin of infection was unknown in all reported cases and the need for confinement was principally due to either attending an asymptomatic patient in 9 cases (6.3%) or to being supposedly in close contact with an asymptomatic person in 22 (15.4%). 60.1% of the residents surveyed reported having lost more than 6months of their training period, and in 18.8% of cases, it was as high as 10 and 12months. There has been a reduction of more than 75% of what was planned in surgical training (P<.05) of tympanoplasty, mastoidectomy, stapedectomy, cochlear implants, endoscopic sinonasal and anterior skull base surgery, septoplasty and turbinoplasty. (AU)

[Impact of the COVID-19 pandemic on the training of otorhinolaryngology residents]. / Impacto de la pandemia COVID-19 en la formación de los residentes de otorrinolaringología.

Background and objectives: Training in surgical specialties has declined during the COVID-19 pandemic. A study was carried out to further analyze the impact of the COVID-19 pandemic on specific aspects of clinical, training, and research activities performed by the otolaryngology residents in Spain. Methods: A cross-sectional qualitative study was conducted during the last two weeks of February 2021. The study consisted of an online survey taken by otolaryngology residents who had undertaken one-year continuing training from February 15, 2020, to February 15, 2021, and consisted of 26 questions exploring the impact of the COVID-19 on the health of the ENT residents and training activities. Categorical variables were reported as frequency and percentage. When indicated, Pearsons Chi-square test (χ2) with Yates's correction and Pearson's correlation coefficient (r) were used. Results: 143 completed surveys were received from 264 residents (54.17%). 36 residents (25.2%) have suffered from the disease due to SARS-CoV-2. Most of them only developed mild symptoms (86.1%), with 3 requiring hospitalization (8.3%). The origin of infection was unknown in all reported cases and the need for confinement was principally due to either attending an asymptomatic patient in 9 cases (6.3%) or to being supposedly in close contact with an asymptomatic person in 22 (15.4%). 60.1% of the residents surveyed reported having lost more than 6 months of their training period, and in 18.8% of cases, it was as high as 10 and 12 months. There has been a reduction of more than 75% of what was planned in surgical training (P < .05) of tympanoplasty, mastoidectomy, stapedectomy, cochlear implants, endoscopic sinonasal and anterior skull base surgery, septoplasty and turbinoplasty. Conclusions: The decline in ENT activity and residents having to assist in other COVID-19 units during the most critical moments of the pandemic, has caused the main reduction in their training capacity. Contagion mainly occurred through contact with asymptomatic carriers during patient care and through supposedly close contact with asymptomatic carriers. Virtual activities have been widely accepted, but they have not completely replaced all residents' training needs. Measures should be implemented to recover lost training, especially surgical practical learning in otology and rhinology.

Usefulness of endonasal flaps and grafts in skull base surgery. Consensus document. / Utilidad de los colgajos e injertos endonasales en cirugía endoscópica nasosinusal y de base de cráneo. Documento de consenso.

INTRODUCTION: Skull base reconstruction is one of the greatest challenges extended endonasal endoscopic surgery. Many grafts and flaps from the endonasal fossa have been demonstrated to be useful in the control of complications such a cerebrospinal fluid leaks. Review and analysis of these resources are necessary in skull base recontruction to improve outcomes. OBJECTIVES: The target is to create a consensus document on the use of different endonasal flaps and grafts in the skull base surgery. MATERIAL AND METHODS: Literature review of the most relevant free grafts and vascularized flaps from the endonasal fossa. Analysis using the Delphi method on the use of the different endonasal resources for endoscopic repair of skull base defects. RESULTS: We obtained two results: 1) A selection of the most representative flaps and grafts from the endonasal fossa, describing origin, surface and indications, based on a literature review. 2) A consensus document, using Delphi methodology, with general considerations (2), recommendations (10) and limitations (6) of the different endonasal flaps and grafts. CONCLUSIONS: We present the first consensus document in the field of extended endonasal endoscopic surgery using the Delphi method as a working tool. We highlight the usefulness of the nasoseptal flap together with other endonasal flaps and grafts for skull base reconstruction.

Usefulness of endonasal mucoplasty in the surgical treatment of chronic rhinosinusitis with nasal polyps. Prospective study.

Chronic Rhinosinusitis with Nasal Polyps (CRScPN) is a disease with great impact on health. The surgical option using endoscopic nasosinus surgery is the therapeutic alternative when control of the disease is not achieved with medical treatment. Extensive endoscopic approaches are being postulated as a possible best surgical treatment option in certain phenotypes of CRScPN. Endonasal mucoplasty associated with these approaches has been shown to be a complementary technique that improves both healing and mucosal oedema in patients with CRScPN in the short term. The aim of our study was to analyse the results of endonasal mucoplasty associated with a complete ethmoid-sphenoidotomy plus grade III frontal sinusotomy in the treatment of CRScPN in the medium term. For this purpose, a prospective case-control study (10/10) was carried out on patients with CRScPN. In the case group, endonasal mucoplasty in the left nostril was associated with surgery, and the control group was not. The assessment of quality of life at one year after surgery, as measured by the mean difference in SNOT-22 (mean [SD]), in the case group was significantly better than in the control group, (45.9 [19.6]-26.6 [16.05], P = 0.027). The endoscopic improvement in healing and mucosal oedema, measured by the Modified Lund-Kennedy scale, showed relevant improvements, when comparing both pits, but without reaching significance (P = 0.29). Endonasal mucoplasty promotes short-term healing, improving the quality of life in the medium term (one year) of patients treated with extensive endoscopic breast resections.

Utilidad de la mucoplastia endonasal en el tratamiento quirúrgico de la rinosinusitis crónica con pólipos nasales. Estudio prospectivo / Usefulness of endonasal mucoplasty in the surgical treatment of chronic rhinosinusitis with nasal polyps. Prospective study

La rinosinusitis crónica con pólipos nasales (RSCcPN) es una enfermedad con gran impacto sobre la salud. La opción quirúrgica mediante cirugía endoscópica nasosinusal es la alternativa terapéutica cuando no se alcanza el control de la enfermedad con el tratamiento médico. Los abordajes endoscópicos extensos se están postulando como posible mejor opción de tratamiento quirúrgico en ciertos fenotipos de RSCcPN. La mucoplastia endonasal asociada a estos abordajes ha demostrado ser una técnica complementaria que mejora tanto la cicatrización como el edema mucoso a corto plazo en pacientes con RSCcPN. El objetivo de nuestro estudio ha consistido en analizar los resultados de las mucoplastia endonasal asociada a una etmoidoesfenoidotomía completa más sinusotomía frontal de grado III en el tratamiento de RSCcPN a medio plazo. Para ello se realizó un estudio prospectivo de casos y controles (10/10) en pacientes con RSCcPN. En el grupo de casos se asoció a la cirugía una mucoplastia endonasal en la fosa nasal izquierda y en el grupo control no. La evaluación de la calidad de vida al año de la intervención quirúrgica, medida mediante la diferencia de medias de SNOT-22 (media [DE]), en el grupo de casos fue significativamente mejor que en el grupo control (45,9 [19,6]-26,6 [16,05]; p=0,027). La mejoría endoscópica de la cicatrización y del edema mucoso, medida mediante la escala de Lund-Kennedy modificada, mostró mejorías relevantes al comparar ambas fosas, pero sin alcanzar la significación (p=0,29). La mucoplastia endonasal favorece la cicatrización a corto plazo, lo que mejora la calidad de vida a medio plazo (un año) de los pacientes tratados con resecciones extensas endoscópicas de los senos. (AU)

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a disease with great impact on health. The surgical option using endoscopic sinus surgery is the therapeutic alternative when control of the disease is not achieved with medical treatment. Extensive endoscopic approaches are being postulated as a possible best surgical treatment option in certain phenotypes of CRSwNP. Endonasal mucoplasty associated with these approaches has been shown to be a complementary technique that improves both healing and mucosal edema in patients with CRSwNP in the short term. The aim of our study was to analyse the results of endonasal mucoplasty associated with a complete ethmoid-sphenoidotomy plus grade III frontal sinusotomy in the treatment of CRSwNP in the medium term. For this purpose, a prospective case-control study (10/10) was carried out on patients with CRSwNP. In the case group, endonasal mucoplasty in the left nostril was associated with surgery, and the control group was not. The assessment of quality of life at one year after surgery, as measured by the mean difference in SNOT-22 (mean [SD]), was significantly better in the case group than in the control group (45.9 [19.6]-26.6 [16.05] P=0.027). The endoscopic improvement in healing and mucosal edema, measured by the Modified Lund-Kennedy scale, showed relevant improvements, when comparing both nostrils, but without reaching significance (P=0.29). Endonasal mucoplasty promotes short-term healing, improving the quality of life in the medium term (one year) of patients treated with extensive endoscopic mucosal resections. (AU)

Estrategias para la práctica de la otorrinolaringología y cirugía de cabeza y cuello durante la fase de control de la COVID-19 / Strategies for the practice of otolaryngology and head and neck surgery during the monitoring phase of COVID-19

La aparición de una nueva enfermedad por coronavirus denominada COVID-19 a finales de 2019 y su expansión pandémica en el mundo ha cambiado la práctica habitual de la especialidad de Otorrinolaringología (ORL). Tras una fase de crecimiento exponencial de los contagios, se ha logrado entrar en una fase de control de la expansión de la enfermedad en la que persiste la posibilidad de contagio, pero la aparición de nuevos casos se considera asumible por el sistema sanitario. El objetivo del presente documento es revisar la evidencia disponible y proponer estrategias y recomendaciones para la práctica médico-quirúrgica de la otorrinolaringología y cirugía de cabeza y cuello, que permitan establecer la actividad habitual, adecuando los estándares de seguridad y eficacia a la situación actual. Se requiere, por lo tanto, identificar y clasificar a los pacientes en función de criterios de estado infeccioso-inmunológico, y establecer las recomendaciones de protección en consultas, hospitalización y quirófano, que eviten la transmisión de la enfermedad a otros usuarios y al personal sanitario, en el contexto específico del desarrollo de nuestra especialidad. El presente documento es fruto de la colaboración de las comisiones científicas y del comité COVID-19 de la SEORLCCC

The appearance of a new coronavirus disease called COVID-19 at the end of 2019 and its pandemic expansion in the world has changed the usual practice of the specialty of Otorhinolaryngology (ENT). After a phase of exponential growth of infections, it has been possible to enter a phase of control of the spread of the disease in which the possibility of infection persists, and the appearance of new cases is considered acceptable by the health system. The aim of this document is to review the available evidence and propose strategies and recommendations for the medical-surgical practice of otorhinolaryngology and head and neck surgery, which allow establishing the usual activity, adapting the safety and efficacy standards to the current situation. Therefore, it is required to identify and classify patients according to criteria of infectious-immunological status, and to establish recommendations for protection in consultations, hospitalization and the operating room, which avoid the transmission of the disease to other users and healthcare personnel, in the specific context of the development of our specialty. This document is the result of the collaboration of all the scientific commissions and the SEORLCCC COVID-19 committee

Strategies for the practice of otolaryngology and head and neck surgery during the monitoring phase of COVID-19. / Estrategias para la práctica de la otorrinolaringología y cirugía de cabeza y cuello durante la fase de control de la COVID-19.

The appearance of a new coronavirus disease called COVID-19 at the end of 2019 and its pandemic expansion in the world has changed the usual practice of the specialty of Otorhinolaryngology (ENT). After a phase of exponential growth of infections, it has been possible to enter a phase of control of the spread of the disease in which the possibility of infection persists, and the appearance of new cases is considered acceptable by the health system. The aim of this document is to review the available evidence and propose strategies and recommendations for the medical-surgical practice of otorhinolaryngology and head and neck surgery, which allow establishing the usual activity, adapting the safety and efficacy standards to the current situation. Therefore, it is required to identify and classify patients according to criteria of infectious-immunological status, and to establish recommendations for protection in consultations, hospitalization and the operating room, which avoid the transmission of the disease to other users and healthcare personnel, in the specific context of the development of our specialty. This document is the result of the collaboration of all the scientific commissions and the SEORLCCC COVID-19 committee.

[Strategies for the practice of otolaryngology and head and neck surgery during the monitoring phase of COVID-19]. / Estrategias para la práctica de la otorrinolaringología y cirugía de cabeza y cuello durante la fase de control de la COVID-19.

The appearance of a new coronavirus disease called COVID-19 at the end of 2019 and its pandemic expansion in the world has changed the usual practice of the specialty of Otorhinolaryngology (ENT). After a phase of exponential growth of infections, it has been possible to enter a phase of control of the spread of the disease in which the possibility of infection persists, and the appearance of new cases is considered acceptable by the health system.The aim of this document is to review the available evidence and propose strategies and recommendations for the medical-surgical practice of otorhinolaryngology and head and neck surgery, which allow establishing the usual activity, adapting the safety and efficacy standards to the current situation. Therefore, it is required to identify and classify patients according to criteria of infectious-immunological status, and to establish recommendations for protection in consultations, hospitalization and the operating room, which avoid the transmission of the disease to other users and healthcare personnel, in the specific context of the development of our specialty. This document is the result of the collaboration of all the scientific commissions and the SEORLCCC COVID-19 committee.

Evaluación de la capacidad formativa del libro del residente de Otorrinolaringología español (FORMIR) como portafolio electrónico / Evaluation of the training capacity of the Spanish Resident Book of Otolaryngology (FORMIR) as an electronic portfolio

INTRODUCCIÓN Y OBJETIVOS: Evaluar la capacidad formativa del libro del residente español como portafolio electrónico para alcanzar los objetivos de aprendizaje de los MIR de Otorrinolaringología (ORL). MÉTODOS: Se realizó una investigación cualitativa multimétodo de características tranversal, temporal y de orientación retrospectiva sobre los MIR de ORL mediante un cuestionario estructurado y una entrevista semiestructurada, sobre la aplicación informática web FORMIR. RESULTADOS: Participaron el 56,5% de los MIR de ORL de alguno de los 63 hospitales españoles acreditados para impartir formación en ORL entre 2009 y 2012. Los resultados obtenidos demostraron que los MIR de ORL que utilizaban el portafolio electrónico eran capaces de autoguiar mejor su aprendizaje, conocían mejor sus objetivos de aprendizaje, cumplían más eficientemente el programa de formación, identificaban más claramente las causas de sus carencias en el aprendizaje y consideraban que FORMIR como portafolio electrónico constituía una herramienta formativa idónea para sustituir al libro del residente en formato papel. CONCLUSIONES: Los MIR de ORL apreciaban de forma muy relevante las prestaciones formativas de FORMIR como portafolio electrónico, especialmente su interfaz, el feedback numérico y automático sobre la adquisición de competencias, su capacidad de almacenamiento de evidencias y su capacidad de visualizarse como logbook de la Unión Europea de Médicos Especialistas o como un curriculum vitae estándar. Este feedback automático facilita el aprendizaje autoguiado. Todo esto hace de FORMIR una herramienta formativa y evaluativa que supera las prestaciones y aceptación de instrumentos similares puestos a disposición de los residentes, que no dudan en proponerlo como el libro del residente más idóneo para facilitar su formación especializada

BACKGROUND AND OBJECTIVES: We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents. METHODS: A multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website. RESULTS: A 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009-2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format. CONCLUSIONS: The ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training

Recomendaciones sobre el uso de la neuromonitorización en cirugía de tiroides y paratiroides / Recommendations on the use of neuromonitoring in thyroid and parathyroid surgery

INTRODUCCIÓN: La cirugía de tiroides y paratiroides (CTPT) se asocia a riesgo de lesión del nervio laríngeo recurrente, nervio laríngeo superior y cambios en la voz. La neuromonitorización intraoperatoria (NMIO), intermitente o continua, en CTPT evalúa el estado funcional de los nervios laríngeos y se utiliza progresivamente con más frecuencia. Esto obliga a adoptar puntos de acuerdo en los aspectos más controvertidos. OBJETIVO: Elaborar un documento de ayuda para orientar en la utilización de la NMIO en CTPT. MÉTODO: Consenso en grupo de trabajo mediante revisión sistemática y método Delphi. RESULTADOS: Se identificaron 7 secciones sobre las que se establecieron puntos de acuerdo: indicaciones, equipo, técnica (parámetros de programación y registro), conducta en pérdida de señal, laringoscopia, voz e implicaciones legales. CONCLUSIONES: La NMIO ayuda en la localización e identificación del nervio laríngeo recurrente, ayuda durante su disección, informa sobre su estado funcional al finalizar la cirugía y permite tomar decisiones en caso de pérdida de señal en el primer lado operado en una tiroidectomía bilateral programada o si había parálisis contralateral previa. La precisión de la NMIO depende de variables como la técnica realizada, la tecnología utilizada y la formación para la correcta ejecución de la técnica e interpretación de la señal. El documento presentado es un punto de inicio para futuros acuerdos en CTPT en cada una de las secciones de consenso

INTRODUCTION: Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary. OBJECTIVE: To develop a support document for guidance on the use of IONM in TPTS. METHOD: Work group consensus through systematic review and the Delphi method. RESULTS: Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications. CONCLUSIONS: IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus

Recommendations on the use of neuromonitoring in thyroid and parathyroid surgery. / Recomendaciones sobre el uso de la neuromonitorización en cirugía de tiroides y paratiroides.

INTRODUCTION: Thyroid and parathyroid surgery (TPTS) is associated with risk of injury to the recurrent laryngeal nerve, superior laryngeal nerve and voice changes. Intraoperative neuromonitoring (IONM), intermittent or continuous, evaluates the functional state of the laryngeal nerves and is being increasingly used. This means that points of consensus on the most controversial aspects are necessary. OBJECTIVE: To develop a support document for guidance on the use of IONM in TPTS. METHOD: Work group consensus through systematic review and the Delphi method. RESULTS: Seven sections were identified on which points of consensus were identified: indications, equipment, technique (programming and registration parameters), behaviour on loss of signal, laryngoscopy, voice and legal implications. CONCLUSIONS: IONM helps in the location and identification of the recurrent laryngeal nerve, helps during its dissection, reports on its functional status at the end of surgery and enables decision-making in the event of loss of signal in the first operated side in a scheduled bilateral thyroidectomy or previous contralateral paralysis. The accuracy of IONM depends on variables such as accomplished technique, technology and training in the correct execution of the technique and interpretation of the signal. This document is a starting point for future agreements on TPTS in each of the sections of consensus.

Evaluation of the training capacity of the Spanish Resident Book of Otolaryngology (FORMIR) as an electronic portfolio. / Evaluación de la capacidad formativa del libro del residente de Otorrinolaringología español (FORMIR) como portafolio electrónico.

BACKGROUND: and objectives We have evaluated the training capacity of the Spanish resident training book as an electronic portfolio to achieve the learning objectives of otorhinolaryngology (ENT) residents. METHODS: A multi-method qualitative investigation with transversal characteristics, temporal and retrospective guidance was performed on Spanish ENT residents using a structured questionnaire, a semi-structured interview, and a computer application on the FORMIR website. RESULTS: A 56.5% of ENT-residents specialising in one of the 63 accredited Spanish hospitals between 2009-2012 participated in the study. The results obtained show that the ENT residents who used the e-portfolio were better able to implement self-guided study, were more aware of their learning objectives, fulfilled the training programme more efficiently, identified the causes of learning gaps more clearly, and considered FORMIR in e-portfolio format to be an ideal training tool to replace the resident training book in paper format. CONCLUSIONS: The ENT residents greatly appreciated the training benefits of FORMIR as an e-portfolio, especially its simple and intuitive interface, the ease and comfort with which they could record their activities, the automatic and numeric feedback on the acquisition of their competencies (which facilitates self-guided learning), its storage capacity for evidence, and its ability to be used as UEMS logbook as well as a standard curriculum vitae. All these features make FORMIR a training and evaluation tool that outperforms similar instruments available to ENT residents. They do not hesitate to identify it as the ideal resident training book for facilitating their specialised training.

Hamartoma condroide laríngeo: un caso excepcional / Chondroid hamartoma of the larynx: an exceptional case

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El melanoma nasofaríngeo: una entidad infrecuente / Nasopharyngeal melanoma: A rare disorder

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