Taponamiento nasal en la epistaxis posterior. Comparación de dos métodos / Nasal packing in posterior epistaxis. Comparison of two methods

Objetivo: Evaluar la tolerancia y eficacia de 2 sistemas de taponamiento nasal para epistaxis posteriores refractarias. Pacientes y métodos: Estudio comparativo longitudinal y prospectivo de 5 años en pacientes que acudieron a Urgencias por epistaxis y precisaron taponamiento posterior. Se consideraron 2 grupos: uno atendido con un sistema de hinchado neumático bicameral (n=105); otro en el que se efectuó oclusión posterior con gasa accediendo por boca y refuerzo anterior (n=47). La tolerancia se midió mediante escala analógica de intensidad dolorosa durante la colocación y mantenimiento del tapón, así como por necesidad de analgesia. La eficacia se valoró por índices de resangrado, necesidad de medidas concomitantes, transfusión de hemoderivados y efectos secundarios. Resultados: En los pacientes con taponamiento hinchable la colocación fue significativamente más rápida (36±19s vs. 228±102s; p<0,001) y menos dolorosa (6,7±1,7 vs. 8,3±1,5; p<0,001), precisando menos analgesia hasta su retirada. El taponamiento de gasa presentó menor porcentaje de resangrados (17% Vs. 26%; p<0,001), menos necesidades de transfusión de hemoderivados (15% vs. 18%; p<0,001) o de otros procedimientos (4% vs. 11%; p<0,001). El gasto sanitario con este último fue menor (1327±202€ vs. 1648±318€; p<0,001) y generó menos complicaciones a corto y largo plazo. Conclusiones: El taponamiento posterior clásico con gasa resulta menos cómodo y rápido de adaptar, pero asegura un mayor porcentaje de éxitos en control de epistaxis, genera menos lesiones locales y reduce costes sanitarios con respecto al neumotaponamiento (AU)

Objective: To evaluate tolerance and efficiency of two nasal blocking systems for posterior refractory epistaxis. Patients and methods: A five year comparative and longitudinal prospective study was developed in patients with epistaxis who attended our Emergency Unit and who required posterior nasal packing. Two groups were considered: one group was treated with a bi-chamber pneumatic inflation system (n=105). In other one, posterior occlusion was carried out with gauze, accessing through the mouth and using nasal reinforcement (n=47). The tolerance was measured by means of an analogue scale of pain intensity during the placement and maintenance of the packing, as well as for the need of analgesia. The efficiency was evaluated by episodes of re-bleeding, need for other concomitant measures, blood transfusion and side effects. Results: In patients with inflatable nasal packing its placement was significantly faster (36±19s vs. 228±102s; p<0.001) and less painful (6.7±1.7 vs. 8.3±1.5; p<0.001), requiring less analgesia until its removal. Patients with pack of gauze showed a lower average incidence of re-bleeding (17% vs. 26 %; p<0.001), fewer cases of blood transfusion (15% vs. 18%; p<0.001) or of other procedures (4% vs. 11 %; p<0.001). The sanitary cost of the latter was also lower (1327±202€ vs. 1648±318€; p<0.001) and it generated less short and long-term complications. Conclusions: The classical posterior packing with gauze is less rapid and comfortable to adapt, but it ensures a higher success rate in the control of epistaxis, produces fewer local injuries and reduces sanitary costs in comparison with inflatable balloon packing (AU)

[Nasal packing in posterior epistaxis. Comparison of two methods]. / Taponamiento nasal en la epistaxis posterior. Comparación de dos métodos.

OBJECTIVE: To evaluate tolerance and efficiency of two nasal blocking systems for posterior refractory epistaxis. PATIENTS AND METHODS: A five year comparative and longitudinal prospective study was developed in patients with epistaxis who attended our Emergency Unit and who required posterior nasal packing. Two groups were considered: one group was treated with a bi-chamber pneumatic inflation system (n=105). In other one, posterior occlusion was carried out with gauze, accessing through the mouth and using nasal reinforcement (n=47). The tolerance was measured by means of an analogue scale of pain intensity during the placement and maintenance of the packing, as well as for the need of analgesia. The efficiency was evaluated by episodes of re-bleeding, need for other concomitant measures, blood transfusion and side effects. RESULTS: In patients with inflatable nasal packing its placement was significantly faster (36+/-19s vs. 228+/-102 s; p<0.001) and less painful (6.7+/-1.7 vs. 8.3+/-1.5; p<0.001), requiring less analgesia until its removal. Patients with pack of gauze showed a lower average incidence of re-bleeding (17% vs. 26 %; p<0.001), fewer cases of blood transfusion (15% vs. 18%; p<0.001) or of other procedures (4% vs. 11 %; p<0.001). The sanitary cost of the latter was also lower (1327+/-202 euro vs. 1648+/-318 euro; p<0.001) and it generated less short and long-term complications CONCLUSIONS: The classical posterior packing with gauze is less rapid and comfortable to adapt, but it ensures a higher success rate in the control of epistaxis, produces fewer local injuries and reduces sanitary costs in comparison with inflatable balloon packing.

[Considerations on acute otitis externa for its optimized treatment]. / Consideraciones sobre la otitis externa aguda para un tratamiento optimizado.

INTRODUCTION AND OBJECTIVES: To evaluate the optimal treatment for diffuse acute otitis externa (DAOE) by means of a new staging system based on clinical and otoscopic findings. METHODS: Monitoring of otitis cases diagnosed at our Centre over the last 21 months (n=1,026), taking into account those who returned for a second visit, either via the emergency service or with a prior appointment. Staging of otitis externa by degree of obstruction of the external auditory canal (EAC): under 25% (type I, n=174); between 25% and 75% (type II; n=277); over 75% (type III; n=359); total obstruction due to organized oedema (type IV; n=216). RESULTS: In most cases at an advanced stage, the canal was cleared by aspiration and placement of gauze or cellulose sponges. Ototopical drops were chosen in more than 95% of cases in every group, but anti-inflammatory and systemic antibiotic agents were administered in significantly larger amounts to patients in stages III and IV. Stage IV showed a statistically significant increase in the percentage of second visits. These manoeuvres improved pain, fullness and otorrhea significantly faster in stages I and II. CONCLUSIONS: Staging of otitis allows comparisons of the level of involvement and treatment recommendations: aspiration is advisable in stages II, III and IV; placement of a wick inside the canal is necessary in stages III and IV. Ototopical drops seem to be needed in every case and systemic antibiotics almost only in stage IV. Acidifying agents and topic glycerine vehicles access the canal better than aqueous solutions and would be the first choice in advanced stages.

Consideraciones sobre la otitis externa aguda para un tratamiento optimizado / Considerations on acute otitis externa for its optimized treatment

Introducción y objetivo: Evaluar el tratamiento idóneo de la otitis externa aguda difusa mediante un nuevo sistema de estadiaje basado en hallazgos clínicos y otoscopia. Métodos: Seguimiento de los casos de otitis diagnosticados en nuestro centro durante los últimos 21 meses (n=1.026). Recuento del número de pacientes que acudieron a una segunda visita urgente o programada. Estadiaje de la otitis externa si la obstrucción del conducto auditivo externo presentaba obstrucción inferior al 25% (tipo I, n=174), entre el 25/75% (tipo II, n=277), mayor del 75% (tipo III, n=359), u obstrucción completa con edema organizado (tipo IV, n=216). Resultados: La aspiración y el mechado del conducto se colocaron en mayor número de casos con estadios avanzados. Las gotas óticas se colocaron en más del 95% en todos los grupos pero los antiinflamatorios y antibióticos sistémicos se administraron significativamente en mayor cantidad a pacientes de estadios III y IV. El estadio IV presentó de forma estadísticamente significativa un mayor porcentaje de segundas visitas. Con estas maniobras, el dolor, el taponamiento y la otorrea cedieron significativamente más rápido en los estadios I y II. Conclusiones: El estadiaje de la otitis externa permite equiparar grados de afectación y recomendar tratamientos: aspiración aconsejable en estadios II, III y IV, mechado siempre en estadios III y IV. Las gotas óticas parecen necesarias en todos los casos y los antibióticos sistémicos casi únicamente en el estadio IV. Los agentes acidificantes y las formas tópicas glicerinadas acceden mejor al conducto que las acuosas y serían de elección en estadios avanzados (AU)

Introduction and objectives: To evaluate the optimal treatment for diffuse acute otitis externa (DAOE) by means of a new staging system based on clinical and otoscopic findings. Methods: Monitoring of otitis cases diagnosed at our Centre over the last 21 months (n=1,026), taking into account those who returned for a second visit, either via the emergency service or with a prior appointment. Staging of otitis externa by degree of obstruction of the external auditory canal (EAC): under 25% (type I, n=174); between 25% and 75% (type II; n=277); over 75% (type III; n=359); total obstruction due to organized oedema (type IV; n=216). Results: In most cases at an advanced stage, the canal was cleared by aspiration and placement of gauze or cellulose sponges. Ototopical drops were chosen in more than 95% of cases in every group, but anti-inflammatory and systemic antibiotic agents were administered in significantly larger amounts to patients in stages III and IV. Stage IV showed a statistically significant increase in the percentage of second visits. These manoeuvres improved pain, fullness and otorrhea significantly faster in stages I and II. Conclusions: Staging of otitis allows comparisons of the level of involvement and treatment recommendations: aspiration is advisable in stages II, III and IV; placement of a wick inside the canal is necessary in stages III and IV. Ototopical drops seem to be needed in every case and systemic antibiotics almost only in stage IV. Acidifying agents and topic glycerine vehicles access the canal better than aqueous solutions and would be the first choice in advanced stages (AU)

[Use of imaging criteria to identify cervical metastases using CT scans in head and neck tumours]. / Empleo de patrones de imagen en la identificación de metástasis cervical mediante tomografía computarizada en tumores de cabeza y cuello.

OBJECTIVE: To assess the diagnostic certainty of CT images to identify regional spread of head and neck tumours. PATIENTS AND METHOD: A CT study was performed on 86 patients with neoplasms in the larynx and/or pharynx. After this, surgical dissection was performed for 142 neck sides. In the imaging study the following parameters were considered for all patients before suspecting malignant nodes: size of adenopathy bigger than 10-11 mm, irregular borders, central necrosis, spherical shape, capsular enhancement and presence of groups with three or more lymphadenopathies. RESULTS: 48.5 % of dissections were N+. Sensitivity and specificity for physical examination were 59 % and 82 %, respectively, against 73 % and 86 % for CT. Lymph node necrosis was the pattern with the greatest sensitivity and specificity (35.8 % and 100 %, respectively) and its accuracy was 69.7 %. Accuracy was 60.5 % for spherical shape, 59.8 % for node size, and between 54 % and 58 % for the other three criteria. In the histopathological findings, 25 % of neck dissections were N+ when only one pattern had been detected on CT, whereas those neck sides in which four patterns were identified simultaneously showed regional spread in 100 %. CONCLUSIONS: The presence of specific morphological imaging criteria for head and neck tumours in cervical lymph nodes and their concomitance increase the accuracy of imaging to predict regional spread.

Empleo de patrones de imagen en la identificación de metástasis cervical mediante tomografía computarizada en tumores de cabeza y cuello / Use of imaging criteria to identify cervical metastases using CT scans in head and neck tumours

Objetivo: Evaluar la seguridad diagnóstica que proporcionan las imágenes de tomografía computarizada (TC) para identificar la extensión regional de tumores de cabeza y cuello (CC). Pacientes y método: Se efectuó TC a 86 pacientes diagnosticados de neoplasia de faringe y/o laringe que después fueron intervenidos, con un total de 142 vaciamientos ganglionares. En el estudio de imagen se consideraron los siguientes parámetros radiológicos para sospechar afección ganglionar: tamaño de la adenopatía > 10-11 mm, márgenes mal definidos, necrosis central, forma esférica, realce capsular y agrupación de tres o más adenopatías. Resultados: El 48,5 % de los vaciamientos resultaron N+. La sensibilidad y la especificidad de la palpación fueron del 59 y el 82 %, respectivamente, y para la TC, del 73 y el 86 %. La necrosis central fue el patrón de imagen con mayor sensibilidad y especificidad, el 35,8 y el 100 % respectivamente, con una eficiencia diagnóstica del 69,7 %. Esta eficiencia fue del 60,5 % para la forma esférica, del 59,8 % para el tamaño, y entre el 54 y el 58 % para los otros tres criterios de imagen. El 25 % de los vaciamientos resultó N+ en el estudio histopatológico cuando en la TC se había hallado sólamente uno de los patrones radiológicos descritos, pero las vertientes cervicales con cuatro patrones identificados simultáneamente presentaron extensión regional en el 100 %. Conclusiones: La presencia de patrones morfológicos específicos en los ganglios cervicales en la TC de tumores de CC y su concomitancia optimizan la eficiencia diagnóstica en esta prueba para predecir la extensión regional

Objective: To assess the diagnostic certainty of CT images to identify regional spread of head and neck tumours. Patients and method: A CT study was performed on 86 patients with neoplasms in the larynx and/or pharynx. After this, surgical dissection was performed for 142 neck sides. In the imaging study the following parameters were considered for all patients before suspecting malignant nodes: size of adenopathy bigger than 10-11 mm, irregular borders, central necrosis, spherical shape, capsular enhancement and presence of groups with three or more lymphadenopathies. Results: 48.5 % of dissections were N+. Sensitivity and specificity for physical examination were 59 % and 82 %, respectively, against 73 % and 86 % for CT. Lymph node necrosis was the pattern with the greatest sensitivity and specificity (35.8 % and 100 %, respectively) and its accuracy was 69.7 %. Accuracy was 60.5 % for spherical shape, 59.8 % for node size, and between 54 % and 58 % for the other three criteria. In the histopathological findings, 25 % of neck dissections were N+ when only one pattern had been detected on CT, whereas those neck sides in which four patterns were identified simultaneously showed regional spread in 100 %. Conclusions: The presence of specific morphological imaging criteria for head and neck tumours in cervical lymph nodes and their concomitance increase the accuracy of imaging to predict regional spread