Aspectos asistenciales de la infección periamigdalina antes y durante la pandemia de COVID-19 / Healthcare aspects of peritonsillar infection before and during the COVID-19 pandemic

Introducción: Este estudio trata de valorar la repercusión de la pandemia sobre la incidencia y la evolución clínica de la infección periamigdalina (IPA).Material y métodosRevisamos en un seguimiento longitudinal y descriptivo retrospectivo las circunstancias de los pacientes atendidos durante 5 años, de 2017 a 2021, en dos hospitales, uno comarcal y otro terciario. Se registraron variables relacionadas con la patología de base, antecedentes de amigdalitis, tiempo de evolución, visitas previas en Atención Primaria, hallazgos en el diagnóstico, relación absceso/flemón y días de estancia hospitalaria.ResultadosDe 2017 a 2019 la incidencia de la enfermedad osciló entre 14 y 16 casos/100.000 habitantes-año, pero en 2020 se redujo a 9,3, un 43% menos. Los pacientes con IPA que consultaron en pandemia generaron pocas visitas previas en servicios de Atención Primaria, presentaron mayor severidad de los síntomas y mayor demora en el diagnóstico. Además, hubo más abscesos que flemones y la necesidad de ingreso hospitalario superior a 24h fue del 66%. Apenas hubo causalidad con amigdalitis agudas, aunque el 66% de los pacientes padecía amigdalitis de repetición, y el 71% patología concomitante. Todos estos hallazgos mostraron diferencias estadísticamente significativas respecto a los casos prepandemia.ConclusionesLa protección de la transmisión aérea, el distanciamiento social y el confinamiento adoptados en nuestro país son medidas que han podido modificar la evolución de la IPA, con una incidencia muy inferior, un período de recuperación mayor y mínima relación con amigdalitis aguda. (AU)

Introduction: This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI).Materials and methodsIn a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded.ResultsFrom 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases.ConclusionsThe protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis. (AU)

Healthcare aspects of peritonsillar infection before and during the COVID-19 pandemic.

INTRODUCTION: This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI). MATERIALS AND METHODS: In a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded. RESULTS: From 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases. CONCLUSIONS: The protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis.

[Healthcare aspects of peritonsillar infection before and during the COVID-19 pandemic]. / Aspectos asistenciales de la infección periamigdalina antes y durante la pandemia de COVID-19.

Introduction: This study assessed if the healthcare system overload and the organizational changes made in response to COVID-19 may be having an impact on clinical and epidemiological characteristics of the peritonsillar infection (PTI). Materials and methods: In a retrospective longitudinal and descriptive follow-up, we reviewed the circumstances of the patients attended during 5 years, from 2017 to 2021, in two hospitals, one regional and other tertiary. Variables related to underlying pathology, history of tonsillitis, time of evolution, previous visits to Primary Care, diagnostic findings, abscess/phlegmon ratio, and length of hospital stay were recorded. Results: From 2017 to 2019, the incidence of the disease ranged between 14 and 16 cases/100,000 inhabitants-year, and decreased to 9.3 in 2020, a 43% less. Patients with PTI consulting in pandemic time were visited much less often in Primary Care services. They showed a greater severity of symptoms and the period of time between their appearance and diagnosis was longer. Additionally, there were more abscesses and the need for hospital admission greater than 24 h was 66%. There was hardly a causal relationship with acute tonsillitis, although 66% of the patients evidenced history of recurrent tonsillitis, and 71% concomitant pathology. All these findings showed statistically significant differences with the pre-pandemic cases. Conclusions: The protection of airborne transmission, the social distancing and the lockdown adopted in our country are measures that seem having been able to modify the evolution of PTI, with a much lower incidence, a longer recovery period and a minimal relationship with acute tonsillitis.

Blood Viscosity in COVID-19 Patients With Sudden Deafness.

BACKGROUND: Changes in blood viscoelastic properties have been proposed previosuly as etiopathogenesis for severe complications in COVID-19 and some cases of Sudden Deafness (SD). This is an attempt to verify if SD cases in patients admitted for SARS-Cov-2 infection can be correlated. PATIENTS AND METHODS: A prospective follow-up was carried out with COVID-19 patients, monitoring their blood viscosity (BV) at high shear rate (300 s-1) and inquiring them periodically for eventual hearing loss. This measurement was extended to cases bearing of SD in 2019 and 2020 without infection and a control group of healthy normoacoustic subjects. RESULTS: The normality range was 4,16 ± 0,62 cps. 330 cases admitted for COVID-19 were evaluated from February 24th, 2020 to March 24th, 2021, 85 of them attended in ICU. After anamnesis and Audiometric Tone Thresholds developed as soon as possible, 9 SD were detected, all belonging to ICU group. The mean BV was 4,38 ± 0,43 cps in the ward group, 4,53 ± 0,39 cps in the ICU patients without SD, and 4,85 ± 0,52 cps in the cases with SD, with statistically significant differences. Highest BV elevations in the SD cases were detected between days 6 and 10 of hospital admission. In 2019 four cases consulted with SD, and another two did it in 2020 without a diagnosis of COVID-19, with normal BV values. CONCLUSIONS: During SARS-Cov-2 infection, patients may show high BV and SS, although an inpatients control group and a larger sample volume are necessary to confirm the predisposition to hyperviscosity. The incidence of hearing damage is considerable if its possible appearance is taken into account, within the limitations of critical patients with COVID-19.

Viscosidad sanguínea en pacientes COVID-19 con sordera súbita / Blood viscosity in COVID-19 patients with sudden deafness

Antecedentes: La alteración en las propiedades viscoelásticas de la sangre ha sido anteriormente propuesta como etiopatogenia de complicaciones severas por COVID-19 y algunos casos de sordera súbita (SS). Pretendemos verificar si la aparición de casos de SS en pacientes ingresados por infección por SARS-CoV-2 puede correlacionarse de este modo. Pacientes y métodos: Estudio longitudinal prospectivo de pacientes ingresados en nuestro Centro por COVID-19, efectuando monitorización de la viscosidad sanguínea (VS) a alta velocidad de cizallamiento (300 seg-1) y un requerimiento periódico personal sobre hipoacusia. Esta determinación se extendió a casos atendidos por SS sin infección en 2019 y 2020 y un grupo control de sujetos sanos normoacúsicos. Resultados: El rango de normalidad se situó en 4,16±0,62 cps. Entre el 24 de febrero de 2020 y el 24 de marzo de 2021 se evaluaron 330 casos ingresados por COVID-19, 85 asistidos en la Unidad de Cuidados Intensivos (UCI). Fueron identificadas tras anamnesis y Audiometría Tonal Liminar (ATL) todo lo inmediata que el status clínico lo permitió hasta nueve casos con SS, todos pertenecientes al grupo de UCI. La VS media fue 4,38±0,43 cps en el grupo de sala, 4,53±0,39 cps en los pacientes en UCI sin SS, y 4,85±0,52 cps en los casos con SS, con diferencias estadísticamente significativas. Las mayores elevaciones de la VS en los casos con SS se detectaron entre los días seis y 10 del ingreso hospitalario. En 2019 consultaron cuatro casos y otros 2 en 2020 sin diagnóstico de COVID-19, con valores normales de VS. Conclusiones: Durante la infección por SARS-CoV-2 los pacientes pueden presentar elevación en la VS y SS, si bien se hacen necesarios un grupo control hospitalario y un volumen muestral mayor para confirmar la predisposición a la hiperviscosidad. La incidencia del daño auditivo resulta considerable si se tiene en cuenta su posible aparición en pacientes críticos con COVID-19. (AU)

Background: Changes in blood viscoelastic properties have been proposed previosuly as etiopathogenesis for severe complications in COVID-19 and some cases of Sudden Deafness (SD). This is an attempt to verify if SD cases in patients admitted for SARS-CoV-2 infection can be correlated. Patients and methods: A prospective follow-up was carried out with COVID-19 patients, monitoring their blood viscosity (BV) at high shear rate (300 sec-1) and inquiring them periodically for eventual hearing loss. This measurement was extended to cases bearing of SD in 2019 and 2020 without infection and a control group of healthy normoacoustic subjects. Results: The normality range was 4,16±0,62 cps. 330 cases admitted for COVID-19 were evaluated from February 24th, 2020 to March 24th, 2021, 85 of them attended in ICU. After anamnesis and Audiometric Tone Thresholds developed as soon as possible, 9 SD were detected, all belonging to ICU group. The mean BV was 4,38±0,43 cps in the ward group, 4,53±0,39 cps in the ICU patients without SD, and 4,85±0,52 cps in the cases with SD, with statistically significant differences. Highest BV elevations in the SD cases were detected between days 6 and 10 of hospital admission. In 2019 four cases consulted with SD, and another two did it in 2020 without a diagnosis of COVID-19, with normal BV values. Conclusions: During SARS-CoV-2 infection, patients may show high BV and SS, although an inpatients control group and a larger sample volume are necessary to confirm the predisposition to hyperviscosity. The incidence of hearing damage is considerable if its possible appearance is taken into account, within the limitations of critical patients with COVID-19. (AU)

Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience.

INTRODUCTION: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. PATIENTS AND METHODS: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. RESULTS: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7 ±â€¯11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. CONCLUSIONS: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.

Factores implicados en el éxito y fracaso de la dacriocistorrinostomía endoscópica desde nuestra experiencia / Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience

Introducción: La dacriocistitis crónica es la patología secundaria a la estenosis del conducto lacrimonasal (ECLN) permanente, generando epífora y conjuntivitis de repetición. La dacriocistorrinostomía endoscópica (DCRE) supone una vía más natural que la vía externa y ofrece tasas de éxito superiores a la técnica láser. Valoramos la experiencia de este centro en este procedimiento. Pacientes y métodos: Se efectuó una revisión retrospectiva de los registros médicos en pacientes adultos sometidos a DCRE por ECLN entre 1995 y 2019 en nuestro centro. El período de seguimiento mínimo requerido después de la cirugía fue de seis meses. Resultados: En 297 meses se efectuaron 167 procedimientos de DCRE sobre 156 pacientes, con una edad media de 65,7±11,6 años y una relación hombre/mujer de 1/1,98. La mejoría funcional fue del 86%, con una tasa de éxito anatómico del 87%. La ausencia de mejoría clínica se correlacionó de forma estadísticamente significativa con la edad del paciente y el tiempo de evolución de la ECLN, la presencia de patología concomitante sistémica (especialmente diabetes mellitus) u oftalmológica, el hallazgo intraoperatorio de un saco lacrimal engrosado y la ausencia de drenaje del mismo al marsupializarlo. Los pacientes con peor respuesta fueron portadores de stents en la rinostomía durante más tiempo. No existieron complicaciones postoperatorias de interés. Conclusiones: La DCRE es una técnica eficaz y segura, fundamentada en referencias anatómicas estables. La incidencia de fracasos parece multifactorial y debe contemplarse en pacientes añosos, pluripatológicos y con largo tiempo de evolución de la enfermedad. (AU)

Introduction: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. Patients and methods: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. Results: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7±11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. Conclusions: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition. (AU)

[Blood viscosity in COVID-19 patients with sudden deafness]. / Viscosidad sanguínea en pacientes COVID-19 con sordera súbita.

Background: Changes in blood viscoelastic properties have been proposed previosuly as etiopathogenesis for severe complications in COVID-19 and some cases of Sudden Deafness (SD). This is an attempt to verify if SD cases in patients admitted for SARS-CoV-2 infection can be correlated. Patients and methods: A prospective follow-up was carried out with COVID-19 patients, monitoring their blood viscosity (BV) at high shear rate (300 sec-1) and inquiring them periodically for eventual hearing loss. This measurement was extended to cases bearing of SD in 2019 and 2020 without infection and a control group of healthy normoacoustic subjects. Results: The normality range was 4,16±0,62 cps. 330 cases admitted for COVID-19 were evaluated from February 24th, 2020 to March 24th, 2021, 85 of them attended in ICU. After anamnesis and Audiometric Tone Thresholds developed as soon as possible, 9 SD were detected, all belonging to ICU group. The mean BV was 4,38±0,43 cps in the ward group, 4,53±0,39 cps in the ICU patients without SD, and 4,85±0,52 cps in the cases with SD, with statistically significant differences. Highest BV elevations in the SD cases were detected between days 6 and 10 of hospital admission. In 2019 four cases consulted with SD, and another two did it in 2020 without a diagnosis of COVID-19, with normal BV values. Conclusions: During SARS-CoV-2 infection, patients may show high BV and SS, although an inpatients control group and a larger sample volume are necessary to confirm the predisposition to hyperviscosity. The incidence of hearing damage is considerable if its possible appearance is taken into account, within the limitations of critical patients with COVID-19.

Factors involved in the success and failure of endoscopic dacryocystorhinostomy from our experience. / Factores implicados en el éxito y fracaso de la dacriocistorrinostomía endoscópica desde nuestra experiencia.

INTRODUCTION: Chronic dacryocystitis is the condition secondary to permanent lacrimonasal duct stenosis (LNDS) that generates epiphora and recurrent conjunctivitis. Endoscopic dacryocystorhinostomy (EDCR) is a more natural route than the external route and offers higher success rates than the laser technique. We value this centre's experience in this procedure. PATIENTS AND METHODS: A retrospective review was carried out in our centre of the medical records of adult patients undergoing EDCR due to LNDS between 1995 and 2019. The minimum follow-up period required after surgery was 6 months. RESULTS: Over 297 months, 167 EDCR procedures were performed on 156 patients, with an average age of 65.7 ± 11.6 years and a male/female ratio of 1/1.98. The functional improvement was 86%, with an anatomical success rate of 87%. Lack of clinical improvement statistically significantly correlated with the age of the patient and the time since onset of the LNDS, the presence of concomitant systemic (especially diabetes mellitus) or ophthalmological disease, the intraoperative finding of a thickened tear sac and absence of drainage of the tear sac when marsupialised. Longer-term stent carriers in the rhinostomy had poorer outcomes. There were no postoperative complications of interest. CONCLUSIONS: EDCR is an effective and safe technique, based on stable anatomical references. Failure rate seems to be multifactorial and should be considered in older, multipathological patients, with a long duration of the condition.

Implicación ORL en infecciones por Leishmania / ENT involvement in Leishmania infections

INTRODUCCIÓN: La leishmaniasis comprende un grupo de enfermedades provocadas por parásitos protozoos del género Leishmania que se transmiten mediante la picadura de la hembra de mosquitos flebotomos infectados desde reservorios animales, generando 3 formas clínicas diferentes: cutánea, mucocutánea y visceral. Presentamos los hallazgos en cabeza y cuello de esta enfermedad observados en nuestra área de salud. PACIENTES Y MÉTODOS: Revisión de los últimos 26 años en nuestro hospital, anotando las características clínicas, diagnósticas y terapéuticas de los casos detectados. RESULTADOS: Fueron identificados 13 casos, 7 con síndrome cutáneo, 4 mucocutáneo y 2 visceral o kala azar. Su edad media fue de 53,7 ± 10,8 años. En un 61% de los casos se verificó inmunodeficiencia. La incidencia de la enfermedad fue de 1,5:100.000 habitantes-año, con una prevalencia del 2%. El 69% de los infectados mostraron afectación del área otorrinolaringológica. En 12 casos el diagnóstico se estableció mediante biopsia de las lesiones. El tiempo desde el inicio clínico al diagnóstico osciló entre 3 y 10 meses. Como tratamiento se emplearon compuestos antimoniales en 11 pacientes y anfotericina B en 3, sola o combinada con el anterior. Una forma cutánea se resolvió con escisión de la lesión. El 92% mostró curación clínica y parasitológica. CONCLUSIONES: La leishmaniasis en España genera frecuentes cuadros de afectación cutánea y mucocutánea, a menudo en la piel de cabeza, cara y cuello o mucosa de vías altas. Su presentación clínica es muy variable, debiéndose sospechar ante la ausencia de respuesta a terapias convencionales y en condiciones de inmunodeficiencia

INTRODUCTION: Leishmaniasis comprises a group of diseases caused by protozoan parasites of the genus Leishmania that are transmitted by the bite of infected phlebotomine mosquitoes from animal reservoirs. Three different clinical forms are generated: cutaneous, mucocutaneous and visceral. We present the findings in the head and neck of this disease observed in our health area. PATIENTS AND METHODS: A review of the last 26 years in our hospital, noting the clinical, diagnostic and therapeutic characteristics of the cases detected. RESULTS: Thirteen cases were identified, 7 cutaneous, 4 mucocutaneous and 2 visceral or kala-azar. The mean age was 53.7 ± 10.8 years. Immunodeficiency was identified in 61% of the cases. The incidence of the disease was 1.5:100,000 inhabitants/year, with a prevalence of 2%. Of those infected, 69% had involvement of the ear-nose-throat area. In 12 cases the diagnosis was established by biopsy of the lesions. The time from clinical debut to diagnosis ranged from 3 to 10 months. Antimony compounds were used as treatment in 11 patients and amphotericin B in 3, alone or combined with the former. One cutaneous form resolved with excision of the lesion. Ninety-two percent healed clinically and parasitologically. CONCLUSIONS: Leishmaniasis in Spain frequently entails cutaneous and mucocutaneous involvement, often of the skin of the head, face and neck or upper-airway mucosa. Its clinical presentation varies greatly, and it should be suspected if there is no response to conventional therapies and in conditions of immunodeficiency

ENT involvement in Leishmania infections. / Implicación ORL en infecciones por Leishmania.

INTRODUCTION: Leishmaniasis comprises a group of diseases caused by protozoan parasites of the genus Leishmania that are transmitted by the bite of infected phlebotomine mosquitoes from animal reservoirs. Three different clinical forms are generated: cutaneous, mucocutaneous and visceral. We present the findings in the head and neck of this disease observed in our health area. PATIENTS AND METHODS: A review of the last 26 years in our hospital, noting the clinical, diagnostic and therapeutic characteristics of the cases detected. RESULTS: Thirteen cases were identified, 7 cutaneous, 4 mucocutaneous and 2 visceral or kala-azar. The mean age was 53.7±10.8 years. Immunodeficiency was identified in 61% of the cases. The incidence of the disease was 1.5:100,000 inhabitants/year, with a prevalence of 2%. Of those infected, 69% had involvement of the ear-nose-throat area. In 12 cases the diagnosis was established by biopsy of the lesions. The time from clinical debut to diagnosis ranged from 3 to 10 months. Antimony compounds were used as treatment in 11 patients and amphotericin B in 3, alone or combined with the former. One cutaneous form resolved with excision of the lesion. Ninety-two percent healed clinically and parasitologically. CONCLUSIONS: Leishmaniasis in Spain frequently entails cutaneous and mucocutaneous involvement, often of the skin of the head, face and neck or upper-airway mucosa. Its clinical presentation varies greatly, and it should be suspected if there is no response to conventional therapies and in conditions of immunodeficiency.

Comentario a «Sialolitectomía transoral combinada con sialoendoscopia versus submaxilectomía abierta para el manejo de litiasis hiliares de la glándula submaxilar» / Comments on «Transoral sialolitectomy combined with sialoendoscopy versus open submaxillectomy for the management of hilar lithiasis of the submandibular gland»

No disponible

Autofonía de etiología infrecuente: síndrome de la trompa patulosa / Uncommon aetiology for autophony: patulous eustachian tube

Presentamos el caso de un paciente con autofonía, diagnosticado de síndrome de la trompa patulosa y tratado mediante cierre de la trompa con catéter según la técnica modificada de Bluestone y Cantekin en el que se obtuvieron buenos resultados tras un año de seguimiento (AU)

We report the case of a patient with autophony diagnosed with a patulous Eustachian tube. The patient was treated according to the technique described by Bluestone and Cantekin, inserting an indwelling catheter into the tube. Good results were obtained after one year of monitoring (AU)

Uncommon aetiology for autophony: patulous eustachian tube.

We report the case of a patient with autophony diagnosed with a patulous Eustachian tube. The patient was treated according to the technique described by Bluestone and Cantekin, inserting an indwelling catheter into the tube. Good results were obtained after one year of monitoring.

Posturografía estática con pruebas dinámicas. Utilidad de los parámetros biomecánicos en la valoración del paciente vestibular / Static posturography with dynamic tests. Usefulness of biomechanical parameters in assessing vestibular patients

Introducción y objetivos: La posturografía permite evaluar el control postural de un sujeto. En este estudio se presentan aquellos parámetros biomecánicos del sistema de posturografía empleado, que han resultado útiles para valorar funcionalmente los pacientes vestibulares de nuestra muestra. Material y métodos: De un total de 89 participantes, 59 eran sujetos sanos y 30 presentaban un trastorno vestibular periférico. Todos ellos realizaron un estudio posturográfico mediante el sistema NedSVE/IBV que combina pruebas estáticas (Romberg) y dinámicas (límites de estabilidad y control rítmico-direccional). Posteriormente se compararon las medidas halladas en uno y otro grupo. Resultados: Los sujetos normales presentaron menores oscilaciones que los enfermos en los distintos parámetros posturográficos estudiados (excepto en el ángulo de desplazamiento)de forma estadísticamente significativa. En la prueba de los límites de estabilidad, aunque los sujetos normales lograron desplazamientos máximos mayores que los enfermos, las diferencias halladas no fueron significativas. En la prueba de control rítmico y direccional, los sujetos normales presentaron resultados más favorables que los patológicos y las diferencias fueron significativas en 3 de los 4 parámetros estudiados: 1) habilidad anteroposterior, 2) habilidad mediolateral, y 3) control y eficacia anteroposterior. Conclusión: Los parámetros del sistema de posturografía estática empleado y la prueba de control rítmico y direccional resultaron de utilidad para discriminar entre los sujetos normales y patológicos de nuestra muestra (AU)

Introduction and objective: Posturography allows evaluating postural control. This study showed the posturographic parameters that were useful for assessing the functional ability to maintain balance in our sample of vestibular patients. Material and methods: Of a total of 89 patients, 59 were healthy subjects and 30 had a peripheral vestibular disorder. The subjects were studied using the posturographic NedSVE/IBV system, combining static (Romberg) and dynamic (stability limits and rhythmic weight shifts) tests. We then compared the measurements found in the groups. Results: Normal subjects showed significantly lower oscillations than our patients in all of the posturographic parameters studied (except the displacement angle). In testing the limits of stability, although normal subjects achieved maximum displacements greater than the subjects with the disorder, the differences found were not significant. In rhythmic weight shift tests, normal subjects showed more favourable results than did the vestibular patients, with significant differences in 3 of the 4 parameters studied: 1) anteroposterior ability, 2) mediolateral ability, and 3) anteroposterior control and efficiency. Conclusion: Rhythmic weight shift tests and the static posturography test parameters used were useful in discriminating among the normal and pathological subjects in this study (AU)

Static posturography with dynamic tests. Usefulness of biomechanical parameters in assessing vestibular patients.

INTRODUCTION AND OBJECTIVE: Posturography allows evaluating postural control. This study showed the posturographic parameters that were useful for assessing the functional ability to maintain balance in our sample of vestibular patients. MATERIAL AND METHODS: Of a total of 89 patients, 59 were healthy subjects and 30 had a peripheral vestibular disorder. The subjects were studied using the posturographic NedSVE/IBV system, combining static (Romberg) and dynamic (stability limits and rhythmic weight shifts) tests. We then compared the measurements found in the groups. RESULTS: Normal subjects showed significantly lower oscillations than our patients in all of the posturographic parameters studied (except the displacement angle). In testing the limits of stability, although normal subjects achieved maximum displacements greater than the subjects with the disorder, the differences found were not significant. In rhythmic weight shift tests, normal subjects showed more favourable results than did the vestibular patients, with significant differences in 3 of the 4 parameters studied: 1) anteroposterior ability, 2) mediolateral ability, and 3) anteroposterior control and efficiency. CONCLUSION: Rhythmic weight shift tests and the static posturography test parameters used were useful in discriminating among the normal and pathological subjects in this study.

Miringoplastias. Un análisis retrospectivo de nuestros resultados / Myringoplasties. A retrospective analysis of our surgical outcomes

Objetivo: El objetivo de este trabajo es presentar, de forma detallada, nuestros resultados en la cirugía de la reconstrucción de la membrana timpánica y sobre todo los diferentes factores que influyen en los resultados con el fin de contrastar su valor pronóstico. Métodos: Hemos revisado un total de 126 miringoplastias desde 2006 hasta 2010, recopilando los datos del paciente, la descripción del defecto anatómico y los aspectos más relevantes de la propia intervención. Resultados: Las perforaciones subtotales (35,7%) fueron las más frecuentes. En el 89,7% se realizó el abordaje transcanal. La técnica medial (underlay) fue la más empleada (97,6%). Como injerto se utilizó principalmente el cartílago (82,5%). Se consiguió un cierre completo de la perforación en el 71,1% a los 6 meses de seguimiento. Las reperforaciones fueron de tipo puntiforme en el 11,9%, parcial en el 11,1% y dehiscencia de los fragmentos de cartílago en el 4,8%. El tiempo medio en el cual se registró el defecto de la cirugía fue a los 3,82 meses. La ganancia auditiva media fue de 12,8 dB a los 6 meses de la intervención. Conclusiones: La miringoplastia constituye una técnica adecuada para la restitución de la integridad timpánica y para la obtención de un beneficio funcional. Un estado de la caja seco y las perforaciones posteriores parecen relacionarse con un mejor pronóstico funcional (AU)

Objective: The aim of this study was to present, myringoplasty case results in our department. Different factors were studied to confirm their prognostic value. Materials and methods: A total of 126 myringoplasties from 2006 until 2010 were reviewed, collecting patient-related details, descriptions of the anatomical defect and the most interesting surgical aspects. Results: Subtotal perforations (35.7%) were the most frequently observed. In 89.7% of the operations, the transcanal approach was preferred. The medial technique (underlay) to the tympanic membrane was the most performed (97.6%). Cartilage was the principal graft used (82.5%). Complete closure of the perforation was obtained in 71.1% of the cases at 6 months follow-up. Recurrences of the perforations were of minimal size in 11.9% of the cases, partial in 11.1% and with a cartilage fragment gap in 4.8%. The mean time in which these defects were registered was 3.82 months. The mean post-operative auditory gain was 12.8 decibels at 6 months. Conclusions: Myringoplasty is an appropriate technique for restoring tympanic integrity and obtaining functional benefit. Dried middle ear mucosa and posterior perforations seem to be related with better functional results (AU)

[Myringoplasties. A retrospective analysis of our surgical outcomes]. / Miringoplastias. Un análisis retrospectivo de nuestros resultados.

OBJECTIVE: The aim of this study was to present, myringoplasty case results in our department. Different factors were studied to confirm their prognostic value. MATERIALS AND METHODS: A total of 126 myringoplasties from 2006 until 2010 were reviewed, collecting patient-related details, descriptions of the anatomical defect and the most interesting surgical aspects. RESULTS: Subtotal perforations (35.7%) were the most frequently observed. In 89.7% of the operations, the transcanal approach was preferred. The medial technique (underlay) to the tympanic membrane was the most performed (97.6%). Cartilage was the principal graft used (82.5%). Complete closure of the perforation was obtained in 71.1% of the cases at 6 months follow-up. Recurrences of the perforations were of minimal size in 11.9% of the cases, partial in 11.1% and with a cartilage fragment gap in 4.8%. The mean time in which these defects were registered was 3.82 months. The mean post-operative auditory gain was 12.8 decibels at 6 months. CONCLUSIONS: Myringoplasty is an appropriate technique for restoring tympanic integrity and obtaining functional benefit. Dried middle ear mucosa and posterior perforations seem to be related with better functional results.

Secuelas de las parálisis faciales periféricas / Sequelae of peripheral facial palsy

Introducción y objetivos: El objeto de este trabajo es el estudio de las secuelas funcionales tras una parálisis facial periférica (PFP) analizando su incidencia y la relación con el grado de disfunción del nervio facial, desde el punto de vista neurofisiológico. Métodos: Presentamos un estudio retrospectivo que recoge un total de 150 casos de PFP. A todos los pacientes se les realizó una electroneurografía (ENG) y una electromiografía (EMG) para conocer el grado de daño axonal así como para evaluar la existencia de signos de reinervación en los músculos explorados y posibles errores de inervación. Resultados: De los enfermos sometidos a estudio, el 31,9% (46) presentaron secuelas. De estos, el 67,4% (31) eran mujeres con resultados estadísticamente significativos (p=0,031). Resultados: De todas las secuelas, las más frecuentes fueron las mioquimias que aparecieron en el 24% (36) de los casos. Los pacientes con el lado izquierdo afecto son los que presentaron mayor un número de secuelas, en el 40,3% (27), con diferencias estadísticamente significativas (p=0,05). La media de porcentaje de lesión axonal en la primera visita en los pacientes que posteriormente desarrollaron secuelas fue de 75,26%, observando que resultados más desfavorables en la ENG se relacionan de forma estadísticamente significativa con la aparición de secuelas (p=0,007). En la EMG de los enfermos con secuelas hemos observado que un mayor grado de denervación se puede considerar un factor de riesgo para la aparición de secuelas (p=0,039). Discusión/Conclusiones: En nuestro estudio hemos podido comprobar que las secuelas de las parálisis faciales son más frecuentes cuando existe una pérdida axonal importante. En este trabajo aparecen otros factores de riesgo hasta ahora no contemplados en la bibliografía como son el sexo femenino y que el lado izquierdo sea el afectado (AU)

Introduction and objectives: The purpose of this work is to study the functional sequelae after peripheral facial palsy (PFP) to analyze its impact and relationship with the degree of facial nerve dysfunction, from the neurophysiological point of view. Methods: We present a retrospective study which includes a total of 150 cases of peripheral facial palsy. All patients underwent electroneurography and electromyography to see the degree of axonal damage and to evaluate the existence of signs of reinervation in the muscles explored or possible innervation errors. Results: Of the patients studied, 31.9% (46) had sequelae; 67.4% (31) were women, a statistically significant result (P=0.031). Of all the sequelae, the most frequent was miochymia which appeared in 24% of cases (36). Patients with left side involvement presented a higher number of sequelae (40.3%, 27 cases) with a statistically significant difference (P=0.05). The average rate of axonal injury on first visit by patients who subsequently developed sequelae was 75.26%; worse results on electroneurography were statistically associated with the onset of sequelae (P=0.007). Electromyography of patients with sequelae shows that a greater degree of denervation could be considered a risk factor for the occurrence of sequelae (P=0.039). Discussion/conclusions: In our study we found that sequelae are more frequent after facial palsy when there is significant axonal loss. This work shows other risk factors so far not mentioned in the literature, such as female gender and left-side involvement (AU)