Necrotizing external otitis: diagnostic clues in the emergency department.

PURPOSE: The assessment of necrotizing external otitis requires a high index of suspicion by the attending physician. The purpose of the study is to determine the accuracy of parameters available at the Emergency Department for the diagnosis of this pathology. METHODS: Retrospective diagnostic accuracy study. Patients consulting at the Emergency Department for longstanding ear swelling, severe otalgia, and failure to respond to topical treatment were included. Otoscopy, physical examination, CT appearance, and analytical results were tested for the diagnosis of necrotizing external otitis, using nuclear imaging as gold standard. Sensitivity, specificity, likelihood ratios and ROC curves were calculated. RESULTS: 24 patients were included; 13 cases were necrotizing external otitis, and 11 cases were other external ear pathologies. Erythrocyte sedimentation rate and C-reactive protein levels were significantly associated with necrotizing external otitis (AUC 0.92 p < 0.001, and 0.8 p < 0.001). Positive likelihood ratios were 10.15 for values of erythrocyte sedimentation rate over 26 mm/h, and 8.25 for C-reactive protein levels over 10 mg/L. Negative likelihood ratios were 0.08 and 0.28, respectively. These results were significant. The rest of clinical and radiological parameters were less accurate. CONCLUSIONS: Erythrocyte sedimentation rate and C-reactive protein are useful parameters in the evaluation of a case of longstanding otitis with clinical suspicion of necrotizing external otitis. If any of them is elevated, the probability of suffering this condition is significantly increased. If they are within normal ranges, an alternative diagnosis should be sought.

Spin-lattice-dynamics analysis of magnetic properties of iron under compression.

Compression of a magnetic material leads to a change in its magnetic properties. We examine this effect using spin-lattice dynamics for the special case of bcc-Fe, using both single- and poly-crystalline Fe and a bicontinuous nanofoam structure. We find that during the elastic phase of compression, the magnetization increases due to a higher population of the nearest-neighbor shell of atoms and the resulting higher exchange interaction of neighboring spins. In contrast, in the plastic phase of compression, the magnetization sinks, as defects are created, increasing the disorder and typically decreasing the average atom coordination number. The effects are more pronounced in single crystals than in polycrystals, since the presence of defects in the form of grain boundaries counteracts the increase in magnetization during the elastic phase of compression. Also, the effects are more pronounced at temperatures close to the Curie temperature than at room temperature. In nanofoams, the effect of compression is minor since compression proceeds more by void reduction and filament bending-with negligible effect on magnetization-than by strain within the ligaments. These findings will prove useful for tailoring magnetization under strain by introducing plasticity.

Directional Scattering Switching from an All-Dielectric Phase Change Metasurface.

All-dielectric metasurfaces are a blooming field with a wide range of new applications spanning from enhanced imaging to structural color, holography, planar sensors, and directionality scattering. These devices are nanopatterned structures of sub-wavelength dimensions whose optical behavior (absorption, reflection, and transmission) is determined by the dielectric composition, dimensions, and environment. However, the functionality of these metasurfaces is fixed at the fabrication step by the geometry and optical properties of the dielectric materials, limiting their potential as active reconfigurable devices. Herein, a reconfigurable all-dielectric metasurface based on two high refractive index (HRI) materials like silicon (Si) and the phase-change chalcogenide antimony triselenide (Sb2Se3) for the control of scattered light is proposed. It consists of a 2D array of Si-Sb2Se3-Si sandwich disks embedded in a SiO2 matrix. The tunability of the device is provided through the amorphous-to-crystalline transition of Sb2Se3. We demonstrate that in the Sb2Se3 amorphous state, all the light can be transmitted, as it is verified using the zero-backward condition, while in the crystalline phase most of the light is reflected due to a resonance whose origin is the contribution of the electric (ED) and magnetic (MD) dipoles and the anapole (AP) of the nanodisks. By this configuration, a contrast in transmission (ΔT) of 0.81 at a wavelength of 980 nm by governing the phase of Sb2Se3 can be achieved.

Layered gallium sulfide optical properties from monolayer to CVD crystalline thin films.

Interest in layered van der Waals semiconductor gallium monosulfide (GaS) is growing rapidly because of its wide band gap value between those of two-dimensional transition metal dichalcogenides and of insulating layered materials such as hexagonal boron nitride. For the design of envisaged optoelectronic, photocatalytic and photonic applications of GaS, the knowledge of its dielectric function is fundamental. Here we present a combined theoretical and experimental investigation of the dielectric function of crystalline 2H-GaS from monolayer to bulk. Spectroscopic imaging ellipsometry with micron resolution measurements are corroborated by first principle calculations of the electronic structure and dielectric function. We further demonstrate and validate the applicability of the established dielectric function to the analysis of the optical response of c-axis oriented GaS layers grown by chemical vapor deposition (CVD). These optical results can guide the design of novel, to our knowledge, optoelectronic and photonic devices based on low-dimensional GaS.

Plasmonic hot-electron reconfigurable photodetector based on phase-change material Sb2S3.

Hot-carrier based photodetectors and enhanced by surface plasmons (SPs) hot-electron injection into semiconductors, are drawing significant attention. This photodetecting strategy yields to narrowband photoresponse while enabling photodetection at sub-bandgap energies of the semiconductor materials. In this work, we analyze the design of a reconfigurable photodetector based on a metal-semiconductor (MS) configuration with interdigitated dual-comb Au electrodes deposited on the semiconducting Sb2S3 phase-change material. The reconfigurability of the device relies on the changes of refractive index between the amorphous and crystalline phases of Sb2S3 that entail a modulation of the properties of the SPs generated at the dual-comb Au electrodes. An exhaustive numerical study has been realized on the Au grating parameters formed by the dual-comb electrodes, and on the SP order with the purpose of optimizing the absorption of the device, and thus, the responsivity of the photodetector. The optimized photodetector layout proposed here enables tunable narrowband photodetection from the O telecom band (λ = 1310 nm) to the C telecom band (λ = 1550 nm).

Interlaboratory study on Sb2S3 interplay between structure, dielectric function, and amorphous-to-crystalline phase change for photonics.

Antimony sulfide, Sb2S3, is interesting as the phase-change material for applications requiring high transmission from the visible to telecom wavelengths, with its band gap tunable from 2.2 to 1.6 eV, depending on the amorphous and crystalline phase. Here we present results from an interlaboratory study on the interplay between the structural change and resulting optical contrast during the amorphous-to-crystalline transformation triggered both thermally and optically. By statistical analysis of Raman and ellipsometric spectroscopic data, we have identified two regimes of crystallization, namely 250°C ≤ T < 300°C, resulting in Type-I spherulitic crystallization yielding an optical contrast Δn ∼ 0.4, and 300 ≤ T < 350°C, yielding Type-II crystallization bended spherulitic structure with different dielectric function and optical contrast Δn ∼ 0.2 below 1.5 eV. Based on our findings, applications of on-chip reconfigurable nanophotonic phase modulators and of a reconfigurable high-refractive-index core/phase-change shell nanoantenna are designed and proposed.

Greater palatine artery pedicled flap for nasal septal perforation repair: radiological study and case series.

PURPOSE: The greater palatine artery (GPA) is one of the main vessels supplying the nasal septum. We recently described a novel technique to reconstruct a nasal septal perforation (NSP) using a GPA flap. This radiological study explores the feasibility and limits of using a GPA flap for an anterior NSP repair. METHODS: We describe our technique for repairing anterior-most NSP. Radiological measurements of the GPA flap and their limits were analysed. Additionally, a cohort of four patients who underwent reconstruction of a NSP with a GPA flap was included. RESULTS: The radiological study of 150 nasal cavities showed a 31.5 ± 2.7 cm2 maximum flap area. Taking into account the retraction process (30%), the remaining area was 22.0 ± 1.9 cm2. The septal area anterior to the GPA was 6.1 ± 2.1 cm2. The septal portion of the flap was larger than the area anterior to the GPA pedicle in all cases. Complete NSP repair was achieved in four patients. All cases of NSP remained closed during the follow-up. CONCLUSION: The unilateral GPA pedicled flap is a useful technique suitable for the reconstruction of anterior-most perforations that are difficult to cover with other endonasal techniques.

Adsorption of Natural Gas Mixtures of Methane, Ethane, and Propane in Nanoporous Carbon: Fully Atomistic Numerical Studies.

Natural gas (NG) is an interesting primary fuel; its larger-scale use is hindered by the difficulties of storing it under high pressures or low temperatures; a viable alternative is its storage via physisorption in porous materials. Most NG adsorption studies have focused on adsorption of pure methane, its primary component. Here we investigate the influence of heavier alkanes commonly found in NG (propane, ethane) on the adsorption process. We present the results of extensive molecular dynamics simulations of mixtures of methane-propane and methane-ethane at T = 300 and 400 K and P = 0-1500 bar in slit-shaped pores with interlayer spacings H = 8-20 Å. We observed that heavier hydrocarbons adsorb preferentially but remain mobile, which is promising for the intended application. We also solved a common problem with simulations of molecules with high adsorption affinity: the difficulty to determine their partial pressure. We developed an Arrhenius-type relationship allowing the calculation of these partial pressures from relationships between energy distributions of the different molecules in the simulations in conditions where a direct determination of these is impractical or impossible.

Incidental Histopathologic Finding of Sinonasal Inverted Papilloma Among Surgically Excised Polyps Increases the Risk of Tumor Recurrence.

Inverted papilloma (IP) is a benign tumor remarkable for its tendency toward recurrence. Local relapse implicates incomplete resection concerning the bone adjacent to tumor base. The high false negative rates on biopsies, mainly when nasal polyps coexist, may affect the surgical management and outcomes. Our objective was to study the impact of preoperative histologic diagnosis in IP recurrence, particularly in patients with pre-surgical diagnosis of inflammatory polyps. A retrospective analysis of 62 patients treated for IP was conducted. Demographic data and information about smoking status, alcohol intake, tumor location, histology, presence of nasal polyps, staging, malignancy, previous biopsies and surgical approach were evaluated to identify factors associated with recurrence. Prevalence of nasal polyps was higher in patients with recurrence. Smoking history, alcohol abuse, staging, histologic type, malignancy and surgical approach were not associated with recurrence. The presence of nasal polyps at endoscopy was inversely associated with the diagnosis of IP at incisional biopsy. Incidental histologic diagnosis of IP after surgery increased the risk of recurrence more than tenfold. Biopsy reporting the diagnosis of IP previous to surgery was inversely associated to recurrence. In patients with IP, coexistence of nasal polyps at initial endoscopy and lack of pathological IP diagnosis prior to surgery are strongly associated with a higher risk of recurrence. When excisional biopsy reports IP incidentally, an early revision surgery should be considered in order to avoid future aggressive surgeries because of tumor recurrence.

Multimorbidities of Pediatric Allergic Rhinitis.

PURPOSE OF REVIEW: Most children and adolescents with allergic rhinitis (AR) present extra-nasal multimorbid conditions, including conjunctivitis, asthma, atopic dermatitis, rhinosinusitis, or seromucous otitis. Additionally, they may present nasal obstructive disorders, such as septal deformity, turbinate enlargement, and adenoidal hyperplasia, which worsen nasal symptoms, especially nasal obstruction. This is a narrative review on the current state of the concomitant presence of AR and one or more multimorbidities. RECENT FINDINGS: The presence of AR and one or more accompanying multimorbidities is associated to a higher severity and duration of the disease, a negative impact on quality of life, with worse control and lack of improvement with medical treatment. Therefore, AR needs to be managed with a multidisciplinary collaborative approach. Pediatric AR needs to be considered in the context of a systemic disease, which requires a coordinated therapeutic strategy.

Development of an International Odor Identification Test for Children: The Universal Sniff Test.

OBJECTIVE: To assess olfactory function in children and to create and validate an odor identification test to diagnose olfactory dysfunction in children, which we called the Universal Sniff (U-Sniff) test. STUDY DESIGN: This is a multicenter study involving 19 countries. The U-Sniff test was developed in 3 phases including 1760 children age 5-7 years. Phase 1: identification of potentially recognizable odors; phase 2: selection of odorants for the odor identification test; and phase 3: evaluation of the test and acquisition of normative data. Test-retest reliability was evaluated in a subgroup of children (n = 27), and the test was validated using children with congenital anosmia (n = 14). RESULTS: Twelve odors were familiar to children and, therefore, included in the U-Sniff test. Children scored a mean ± SD of 9.88 ± 1.80 points out of 12. Normative data was obtained and reported for each country. The U-Sniff test demonstrated a high test-retest reliability (r27 = 0.83, P < .001) and enabled discrimination between normosmia and children with congenital anosmia with a sensitivity of 100% and specificity of 86%. CONCLUSIONS: The U-Sniff is a valid and reliable method of testing olfaction in children and can be used internationally.

Abordajes endoscópicos a la base de cráneo anterior / Endoscopic approaches to the anterior skull base

Los abordajes endoscópicos a la base de cráneo anterior se han desarrollado de forma muy importante en las últimas décadas y continúan extendiéndose paralelamente a la aparición de nuevo instrumental y equipo que facilitan su aplicación. Factores importantes que han contribuido a ello son la posibilidad de acceder de forma directa a zonas difíciles y la disminución de morbilidad que pueden aportar, manteniendo los resultados esperados. Pero también tienen desventajas y limitaciones pues requieren conocimiento anatómico y el uso de material específico en un campo quirúrgico limitado por el espacio, estructuras anatómicas vitales y la visión bidimensional. La correcta planificación quirúrgica y la selección de los pacientes son elementos fundamentales. Esto nos permitirá determinar si es posible este tipo de abordaje, conocer la localización de la lesión, la zona de entrada al cráneo y el corredor que deberemos utilizar para ello. Los abordajes endoscópicos, correctamente indicados y planificados son procedimientos seguros y efectivos (AU)

Endoscopic approaches to the anterior skull base have grown very significantly in recent decades and continue expanding parallel to the emergence of new instruments and equipment. Important factors that have contributed to this are the ability to access difficult areas with a direct route and associated decreased morbidity with similar surgical outcomes. But they also have disadvantages and limitations, as they require anatomical knowledge and the use of specific material in a surgical field limited by space, vital anatomical structures and two-dimensional view. The correct surgical planning and patient selection are critical elements. This will allow us to determine if this type of approach is possible, to know the location of the lesion, the entry point to the skull and the corridor through which the entry point will be achieved. Endoscopic approaches to the anterior skull base, as long as correctly indicated and planned, are safe and effective procedures (AU)

Cross-cultural adaptation and validation of the sino-nasal outcome test (SNOT-22) for Spanish-speaking patients.

Our objective was to perform translation, cross-cultural adaptation and validation of the sino-nasal outcome test 22 (SNOT-22) to Spanish language. SNOT-22 was translated, back translated, and a pretest trial was performed. The study included 119 individuals divided into 60 cases, who met diagnostic criteria for chronic rhinosinusitis according to the European Position Paper on Rhinosinusitis 2012; and 59 controls, who reported no sino-nasal disease. Internal consistency was evaluated with Cronbach's alpha test, reproducibility with Kappa coefficient, reliability with intraclass correlation coefficient (ICC), validity with Mann-Whitney U test and responsiveness with Wilcoxon test. In cases, Cronbach's alpha was 0.91 both before and after treatment, as for controls, it was 0.90 at their first test assessment and 0.88 at 3 weeks. Kappa coefficient was calculated for each item, with an average score of 0.69. ICC was also performed for each item, with a score of 0.87 in the overall score and an average among all items of 0.71. Median score for cases was 47, and 2 for controls, finding the difference to be highly significant (Mann-Whitney U test, p < 0.001). Clinical changes were observed among treated patients, with a median score of 47 and 13.5 before and after treatment, respectively (Wilcoxon test, p < 0.001). The effect size resulted in 0.14 in treated patients whose status at 3 weeks was unvarying; 1.03 in those who were better and 1.89 for much better group. All controls were unvarying with an effect size of 0.05. The Spanish version of the SNOT-22 has the internal consistency, reliability, reproducibility, validity and responsiveness necessary to be a valid instrument to be used in clinical practice.

Abordajes endoscópicos hipofisarios: dificultades y retos / Endoscopic approaches to pituitary lesions: Difficulties and challenges

Introducción y objetivos: La evolución de los abordajes quirúrgicos a la región hipofisaria aporta beneficios al paciente, pero también supone cambios para los otorrinolaringólogos que tienen que afrontar nuevas dificultades y complicaciones. El objetivo de este trabajo es presentar nuestra experiencia en el abordaje endoscópico de la región hipofisaria, valorando las dificultades y complicaciones encontradas, así como los posibles elementos de mejora. Material y método: Se revisan los primeros 40 casos de abordajes hipofisarios que hemos realizado entre los años 2008 y 2011. Las intervenciones se han realizado por un equipo compuesto por neurocirujanos y otorrinolaringólogos en colaboración simultánea. Se analiza la patología intervenida, las complicaciones y las dificultades encontradas. Resultados: Fueron intervenidos 37 pacientes con tumores hipofisarios y 3 con quistes. Treinta y cuatro casos eran macroadenomas. Las complicaciones fueron 6 fístulas de líquido cefalorraquídeo, 3 de ellas con meningitis, 6 diabetes insípida, un tromboembolismo pulmonar, una hidrocefalia y 4 complicaciones nasales leves. Conclusiones: La frecuencia y el tipo de complicaciones dependen de la extensión de los abordajes endoscópicos, la edad del paciente, el tamaño del tumor y la extensión supraselar. La utilización de instrumental específico, navegador y la valoración del preoperatorio de las pruebas de imagen contribuyen a minimizar las complicaciones. La prudencia en la realización de nuevos abordajes, el conocimiento de las técnicas y las complicaciones, así como el análisis de la actividad realizada, permiten seguir avanzando en los accesos a la patología de la base de cráneo (AU)

Introduction and objectives: The evolution of surgical approaches to the pituitary region brings benefits to the patient, but also means changes for otolaryngologists, who have to face new difficulties and complications. The objective of this paper was to present our experience in the endoscopic approach to the pituitary region, assessing the difficulties and complications encountered, and to offer possible elements for improvement. Material and method: We reviewed the first 40 cases of pituitary approaches we carried out between 2008 and 2011. Interventions were performed by a team of neurosurgeons and otolaryngologists in simultaneous collaboration. We analysed the pathology intervened, complications and difficulties. Results: There were 37 patients operated on for pituitary tumours and 3 cysts; 34 cases were macroadenomas. The complications were 6 cerebrospinal fluid leaks, 3 with meningitis, 6 diabetes insipidus, 1 pulmonary embolism, 1 hydrocephalus and 4 mild nasal complications. Conclusions: The frequency and type of complications depend on the extent of the endoscopic approach, patient age, tumour size and suprasellar extension. The use of specific instruments, navigation and preoperative assessment of imaging tests help to minimise complications. Prudent implementation of new approaches, knowledge of techniques and complications, and the analysis of the activity allow further progress in access to skull base pathology (AU)

Endoscopic approaches to pituitary lesions: difficulties and challenges.

INTRODUCTION AND OBJECTIVES: The evolution of surgical approaches to the pituitary region brings benefits to the patient, but also means changes for otolaryngologists, who have to face new difficulties and complications. The objective of this paper was to present our experience in the endoscopic approach to the pituitary region, assessing the difficulties and complications encountered, and to offer possible elements for improvement. MATERIAL AND METHOD: We reviewed the first 40 cases of pituitary approaches we carried out between 2008 and 2011. Interventions were performed by a team of neurosurgeons and otolaryngologists in simultaneous collaboration. We analysed the pathology intervened, complications and difficulties. RESULTS: There were 37 patients operated on for pituitary tumours and 3 cysts; 34 cases were macroadenomas. The complications were 6 cerebrospinal fluid leaks, 3 with meningitis, 6 diabetes insipidus, 1 pulmonary embolism, 1 hydrocephalus and 4 mild nasal complications. CONCLUSIONS: The frequency and type of complications depend on the extent of the endoscopic approach, patient age, tumour size and suprasellar extension. The use of specific instruments, navigation and preoperative assessment of imaging tests help to minimise complications. Prudent implementation of new approaches, knowledge of techniques and complications, and the analysis of the activity allow further progress in access to skull base pathology.

Long-term clinical trial of tinnitus retraining therapy.

OBJECTIVE: To demonstrate the efficacy of tinnitus retraining therapy (TRT) for tinnitus relief compared to a waiting list group and a partially treated group (patients that refused prosthesis adaptation). STUDY DESIGN: Prospective non-randomised clinical assay (n = 158). Visual analogue scale (VAS) for intensity and the Tinnitus Handicap Inventory (THI) were evaluated at 12-month period. RESULTS: Eighty two percent of the patients that followed TRT improved their tinnitus according to their self-evaluation. THI score was reduced from 48% to 32% and VAS decreased from 6.6 to 5.3 after one year (p < 0.05). TRT patients showed a higher improvement on their tinnitus, THI and VAS scores when compared with the waiting list patients and with patients that refused prosthesis adaptation when recommended (p < 0.05). CONCLUSIONS: TRT improved tinnitus in 82% of the subjects and statistically reduced THI and VAS scores after 12 months. TRT has shown to be more effective than a waiting list group and partially treated patients. EBM RATING: B-2.

Evaluación de la calidad y la satisfacción de la recuparación posanestésica de los pacientes operados en el Hospital de Clínicas / Evaluation of quality and satisfaction of postanesthetic recovery of the patients operated in the Hospital de Clínicas

La evaluación de la calidad asistencial a través de resultados (morbilidad y mortalidad) deja de lado la experiencia subjetiva del paciente. En este estudio se analizó el aspecto subjetivo de la recuperación anestésica mediante una escala visual análoga de satisfacción (EVA) y un cuestionario dirigido a evaluar la calidad de la asistencia anestesiológica. Se entrevistaron, a las 24 horas del alta de la sala de recuperación, 166 pacientes operados de coordinación. A cada pregunta se le asignó un valor numérico y se construyó un score global de calidad (QoR39). Las preguntas se agruparon en función a cinco aspectos de la recuperación: confort, emociones, independencia física, apoyo psicológico y dolor. El valor promedio del QoR39 fue de 175,33±ll,3 (89,9 por ciento del puntaje máximo). Los aspectos que mostraron valores más altos de puntuación fueron el apoyo psicológico y el dolor; y los más bajos fueron la independencia física y el confort. Las emociones obtuvieron un valor intermedio. Existen diferencias significativas entre los promedios del QoR39 en relación al tipo de anestesia, complicaciones en el área de recuperación y estado físico (ASA 3). El promedio del valor de la escala de satisfacción fue de 7,45±1,87; un 30 por ciento de la población señala valores menores a 7, un 38 por ciento marcó valores entre 7 y 8,5 y un 30 por ciento entre 9 y 10. Se identificó una relación directa entre los valores de EVA y de QoR39 con r=0,73 (p < 0,007). La experiencia del paciente evaluada a través de la satisfacción global (EVA) y de la calidad de recuperación (QoR39) constituye una medida cuantitativa de la calidad de recuperación posoperatoria y nos permite realizar un seguimiento del proceso de atención, identificando los aspectos que más se afectan por la cirugía y la anestesia en la población hospitalaria.