Effect of Tinnitus in Distortion Products Otoacoustic Emissions (DPOAEs) in Normal Hearing Patients.

Tinnitus is a symptom whose pathophysiology remains still unclear. Its diagnosis and treatment is complicated, due to its subjectivity. The generation of tinnitus is commonly linked with the impaired functioning of the outer hair cells (OHC) inside the cochlea. Distortion product otoacoustic emissions (DPOAEs) are the objective test used to assess their activity. This study investigates the cochlear outer hair cell function in patients with tinnitus and normal hearing using DPOAEs. We performed a prospective study of the cochlear function in normal hearing patients complaining of tinnitus by analysing DPOAEs amplitude and signal/noise (S/N) ratio. We gathered a sample of 21 ears from adults that attended to the ENT Department complaining of tinnitus with normal hearing. We compared their results with a control group of 21 ears, with the same demographic characteristics, presenting normal hearing but without tinnitus in order to exclude the influence of age in DPOAEs results. A decreased mean of S/N levels in DPOAEs was found in tinnitus and normal hearing group comparing with control group, although these differences were not statistically significant (p > 0.05). Based on the results, OHC dysfunction is not necessary to experience tinnitus. The majority of the patients that present OHC dysfunction do not present a tinnitus at the moment. Other mechanisms in auditory pathway may be evaluated in the tinnitus development.

Cepstral analysis in patients with a vocal fold motility impairment: advantages of the cepstrum over time-based acoustic analysis.

OBJECTIVES: To determine the usefulness of the smoothed cepstral peak prominence (CPPS) in sustained vowel as objective measure of dysphonia. STUDY DESIGN: This is a retrospective cohort study. 49 patients presenting a vocal cord motility impairment between 2012 and 2018 were included. METHODS: Classical acoustic parameters, including jitter, shimmer and NHR, as well as the CPPS were obtained for each patient with a vocal cord motility impairment confirmed by means of a fiberoptic laryngoscopy. We calculated the S/E ratio of each patient to establish the glottal efficiency. An independent sample t test and a Pearson correlation test were used to compare data. RESULTS: Patients presenting a vocal cord motility impairment present abnormal values of the CPPS. Those patients presenting a vocal cord paralysis present lower values of those presenting a vocal cord paresis, with statistically significant difference (P < 0.005). CPPS and the S/E ratio present a moderate negative correlation (- 0.29). CONCLUSIONS: Subjects with a vocal cord motility impairment present abnormal values for CPPS and those values are lower, the greater the motility impairment is. Therefore, CPPS presents as an objective, measurable and reproducible acoustic parameter of dysphonia that will improve the evaluation of patients presenting vocal pathologies.

Validation of the Spanish Version of the STOP-Bang Questionnaire: Usefulness as a Screening Tool for Obstructive Sleep Apnea in Adults.

OBJECTIVES: Obstructive sleep apnea syndrome (OSAS) is an increasing health problem, the diagnosis of which is generally delayed due to long waiting lists for the tests used to identify it. Therefore, tools that help on classifying patients at higher risk of suffering this syndrome have been developed. METHODS: One hundred ninety-three consecutive patients, with and without OSAS, filled in the Spanish version of the STOP-Bang questionnaire in Hospital Universitario de Torrejón (Spain). Polysomnographies were performed to diagnose the presence and severity of the OSAS. Statistics analysis of the demographic characteristics of the sample and the questionnaire results was performed. RESULTS: Most patients were male (73%) and the mean age was 50.4 years (ranging from 19-77 years). Cronbach α coefficient in the sample was 0.8072. A statistically significant difference was noted in the questionnaire scores between patients with OSAS and those without the syndrome. CONCLUSIONS: The Spanish version of the STOP-Bang questionnaire possess a good internal consistency that allows us to rely on it as a screening tool for patients with OSAS. In our sample, a difference in the questionnaire score was appreciated between patients with and without the syndrome, which strongly supports the utility of the questionnaire for its purpose.

Inyección intralesional de corticoide como tratamiento para la estenosis subglótica idiopática / Intralesional corticosteroid injection for treatment of idiopathic subglottic stenosis

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Castleman's disease as an unusual cause for dysphagia and dyspnea in a pediatric patient.

Castleman's disease is a very rare entity in pediatric population and its presentation in the neck is scarcely described in the literature. We present the case of a 10-year-old-girl with an expanding neck mass over several months causing dysphagia and dyspnea. Surgical excision of the mass was performed and the analysis revealed unicentric Castleman's Disease. This is the second largest reported case of neck pediatric CD in the literature, and it presented with a symptomatology that differs from the other cases described. This fact highlights the need to include CD in the differential diagnosis of pediatric neck masses.

Vocal Changes Following Thyroid Surgery: Prospective Study of Objective and Subjective Parameters.

OBJECTIVE: Vocal changes are frequent following a surgical procedure to the thyroid gland. Even though they are a recognized morbidity, their bases are yet to be defined as well as their effect on vocal parameters. This study investigates the objective and subjective changes that occur after the surgery. STUDY DESIGN: This study is a prospective analysis of consecutive cases. SETTING: This study was conducted in a single-center tertiary care facility. SUBJECTS AND METHODS: Patients programmed for any thyroid procedure in Hospital Universitario Ramón y Cajal were enrolled consecutively to perform the vocal analysis before and after the surgery from April 2014 to April 2016. Patients were divided according to the vocal fold motility, and their vocal and aerodynamic parameters were obtained by means of electroglottography and phonatory aerodynamic system. Patients filled in the 10-item Voice Handicap Index (VHI-10) questionnaire. Statistical analysis was performed comparing vocal and aerodynamic parameters and quality of life before and after the surgery. RESULTS: 218 patients met inclusion criteria and completed the protocol. A total of 86.6% of the sample showed no vocal motility impairment, whereas the rest of the patients showed a paresis or a paralysis. Maximum phonatory time and VHI-10 questionnaire showed a statistically significant difference (P < 0.05) between groups. No differences were assessed regarding other vocal parameters. CONCLUSIONS: Efforts are still needed to understand the groundings and magnitude of the vocal changes after a thyroid surgery.

Evaluation of resident's training for endoscopic sinus surgery using a sheep's head.

Training in functional endoscopic sinus surgery (FESS) is an essential part of each ENT resident and it takes place on a very fragile area. This study focus on showing the learning curve of FESS, using an anatomical model such as the sheep's head. Four residents in our centre performed dissections. Each of these residents operated eight sheep's head. They performed an endoscopic septoplasty followed by maxillary antrostomy, total ethmoidectomy and frontal sinusotomy on every head. A staff member guided all procedures and checked for the appropriate dissection and complications occurred. Analysis was made upon the residents' performance of their first four septoplasties and eight nasal sides against their subsequent performance of the same. Final procedures presented better outcomes than the initial ones on every step of them. Results were measured by means of decrease of time (P < 0.0001) and complications, showing no major complications on the latest ones. Sheep's head is a suitable substitute for the cadaveric human head, to obtain the surgical skills needed for FESS procedures. Sheep's nasal cavity allows gaining dexterity and it is an easy model to obtain.

Primary Sarcomatoid Tumor of the Bladder: A Different Entity but the Same Approach?

Bladder cancer remains a frequent cancer worldwide, and most tumors are diagnosed at localized stages. Urothelial carcinoma (UC) accounts for 90% of bladder cancer cases. Sarcomatoid carcinoma (SaC) of the bladder is a rare variant (0.5% of total bladder cancers) characterized by 2 components based on histology; the epithelial and mesenchymal phenotypes, which can be easily differentiated by immunohistochemistry. SaC has similar epidemiologic features to UC but different behavior, aggressiveness, and prognosis. In this review, we summarize the main differences between UC bladder cancers and SaC subtypes. The therapeutic strategies used in SaC today do not differ much from those used for the urothelial variant. However, there is still no standard treatment--the result of a lack of clinical trials for the sarcomatoid variant. Further multicenter comparative studies are needed to devise a better treatment strategy for patients with this rare histologic tumor subtype.