Guía de práctica clínica sobre el manejo del schwannoma vestibular / Clinical practice guideline on the management of vestibular schwannoma

Introducción: El schwannoma vestibular (SV) es el tumor más frecuente del ángulo pontocerebeloso. La mayor accesibilidad a las pruebas radiológicas ha incrementado su diagnóstico. Teniendo en cuenta las características del tumor, la clínica y la edad del paciente se han propuesto tres estrategias terapéuticas, observación, cirugía o radioterapia. La elección de la más adecuada para cada paciente es un motivo de controversia frecuente. Material y métodos: El presente trabajo incluye una revisión exhaustiva sobre cuestiones relativas al SV que pueden servir de guía clínica en el manejo de pacientes con estas lesiones. La presentación se ha orientado en forma de preguntas que el clínico se hace habitualmente y las respuestas están redactadas y/o revisadas por un panel de expertos nacionales e internacionales consultados por la Comisión de Otología de la SEORL-CCC. Resultados: Se ha elaborado un listado con los 13 bloques temáticos más controvertidos sobre el manejo del SV en forma de 50 preguntas y se han buscado las respuestas a todas ellas mediante una revisión sistemática de la literatura (artículos publicados en PubMed y Cochrane Library entre 1992 y 2023 sobre cada bloque temático). Treinta y tres expertos, liderados por la Comisión de Otología de la SEORL-CCC, han analizado y discutido todas las respuestas. En el Anexo 1 pueden encontrarse 14 preguntas adicionales divididas en cuatro bloques temáticos. Conclusiones: Esta guía de práctica clínica sobre el manejo del SV ofrece respuestas consensuadas a las preguntas más habituales que se plantean sobre este tumor. La ausencia de suficientes estudios prospectivos hace que los niveles de evidencia sobre el tema sean en general medios o bajos. Este hecho incrementa el interés de este tipo de guías de práctica clínica elaboradas por expertos.(AU)

IntroductionVestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. The greater accessibility to radiological tests has increased its diagnosis. Taking into account the characteristics of the tumour, the symptoms and the age of the patient, three therapeutic strategies have been proposed: observation, surgery or radiotherapy. Choosing the most appropriate for each patient is a frequent source of controversy. Material and methods: This paper includes an exhaustive literature review of issues related to VS that can serve as a clinical guide in the management of patients with these lesions. The presentation has been oriented in the form of questions that the clinician usually asks himself and the answers have been written and/or reviewed by a panel of national and international experts consulted by the Otology Commission of the SEORL-CCC. Results: A list has been compiled containing the 13 most controversial thematic blocks on the management of VS in the form of 50 questions, and answers to all of them have been sought through a systematic literature review (articles published on PubMed and Cochrane Library between 1992 and 2023 related to each thematic area). Thirty-three experts, led by the Otology Committee of SEORL-CCC, have analyzed and discussed all the answers. In Annex 1, 14 additional questions divided into 4 thematic areas can be found. Conclusions: This clinical practice guideline on the management of VS offers agreed answers to the most common questions that are asked about this tumour. The absence of sufficient prospective studies means that the levels of evidence on the subject are generally medium or low. This fact increases the interest of this type of clinical practice guidelines prepared by experts.(AU)

Comparison of the MIPS technique versus linear incision with tissue preservation in osseointegrated implants in the Ponto model®.

BACKGROUND AND OBJECTIVES: The surgery of osseointegrated implants has undergone different modifications over the years with the aim of achieving better results and facilitating the surgical technique. Today the most commonly used technique is the linear incision with tissue preservation and placement of the abutment and implant. The long-term success of this technique has served as the basis for the development of the so-called minimally invasive surgical approach (MIPS). This study compares the short-, medium- and long-term results between the classic linear incision technique and the MIPS technique. MATERIAL AND METHODS: A prospective study was conducted on patients who had an osseointegrated implant placed between February 2016 and February 2020. A total of 59 surgeries were performed, 32 surgeries according to the linear incision technique with tissue preservation and 27 with MIPS technique. Outcomes were evaluated at one week, one month and one year. RESULTS: Statistically significant differences were achieved between the 2 groups at one week after surgery. Eighty per cent of the MIPS patients had Holgers grades 0-1 compared to 35% of the linear technique patients (p = 0.001). No statistically significant differences were observed at one month (p = 0.457) and one year (p = 0.228). One case with grade 4 was recorded which resulted in implant extrusion one month after surgery with the MIPS technique. A new osseointegrated implant was placed 2 months after the fall using the same MIPS technique with good results. We were also able to verify that the duration of surgery was much shorter with the MIPS technique and better tolerated in terms of postoperative discomfort by the patient. CONCLUSIONS: In our experience, the MIPS technique is the technique of choice for surgery of osseointegrated Ponto model implants as it is simpler, faster and presents fewer problems in the immediate postoperative period, with similar long-term postoperative results.

Clinical practice guideline on the management of vestibular schwannoma.

INTRODUCTION: Vestibular schwannoma (VS) is the most common tumour of the cerebellopontine angle. The greater accessibility to radiological tests has increased its diagnosis. Taking into account the characteristics of the tumour, the symptoms and the age of the patient, three therapeutic strategies have been proposed: observation, surgery or radiotherapy. Choosing the most appropriate for each patient is a frequent source of controversy. MATERIAL AND METHODS: This paper includes an exhaustive literature review of issues related to VS that can serve as a clinical guide in the management of patients with these lesions. The presentation has been oriented in the form of questions that the clinician usually asks himself and the answers have been written and/or reviewed by a panel of national and international experts consulted by the Otology Commission of the SEORL-CCC. RESULTS: A list has been compiled containing the 13 most controversial thematic blocks on the management of VS in the form of 50 questions, and answers to all of them have been sought through a systematic literature review (articles published on PubMed and Cochrane Library between 1992 and 2023 related to each thematic area). Thirty-three experts, led by the Otology Committee of SEORL-CCC, have analyzed and discussed all the answers. In Annex 1, 14 additional questions divided into 4 thematic areas can be found. CONCLUSIONS: This clinical practice guideline on the management of VS offers agreed answers to the most common questions that are asked about this tumour. The absence of sufficient prospective studies means that the levels of evidence on the subject are generally medium or low. This fact increases the interest of this type of clinical practice guidelines prepared by experts.

Clinical Impact of Genetic Diagnosis of Sensorineural Hearing Loss in Adults.

HYPOTHESIS: Adult genetic sensorineural hearing loss (SNHL) may be underestimated. BACKGROUND: The diagnosis of genetic hearing loss is challenging, given its extreme genetic and phenotypic heterogeneity, particularly in adulthood. This study evaluated the utility of next-generation sequencing (NGS) in the etiological diagnosis of adult-onset SNHL. MATERIALS AND METHODS: Adults (>16 yr old) with SNHL were recruited at the Otolaryngology Department at Marqués de Valdecilla University Hospital (Spain). Environmental factors, acoustic trauma, endolymphatic hydrops, and age-related hearing loss were excluding criteria. An NGS gene panel was used, including 196 genes (OTOgenics v3) or 229 genes (OTOgenics v4) related to syndromic and nonsyndromic hearing loss. RESULTS: Sixty-five patients were included in the study (average age at the onset of SNHL, 41 yr). Fifteen pathogenic/likely pathogenic variants considered to be causative were found in 15 patients (23% diagnostic yield) in TECTA (4), KCNQ4 (3), GJB2 (2), ACTG1 (1), COL2A1 (1), COCH (1), COCH/COL2A1 (1), STRC (1), and ABHD12 (1). Three patients had syndromic associations (20% of patients with genetic diagnosis) that had not been previously diagnosed (two Stickler type I and one polyneuropathy, hearing loss, ataxia, retinitis pigmentosa, cataract syndrome). Seven variants of unknown significance were found in COL11A1 (1), GSMDE (2), DNTM1 (1), SOX10 (1), EYA4 (1), and TECTA (1). CONCLUSION: NGS gene panels can provide diagnostic yields greater than 20% for adult SNHL, with a significant proportion of variant of unknown significance that could potentially contribute to increasing diagnostic output. Identifying a genetic cause enables genetic counseling, provides prognostic information and can reveal unrecognized syndromes contributing to an accurate management of their associated manifestations.

Absceso septal espontáneo como causa de shock séptico / Spontaneous septal abscess as the cause of septic shock

No disponible

Tratamiento con toxina botulínica del síndrome del primer mordisco / Treatment of the first bite syndrome

El síndrome del primer mordisco es una secuela potencial de la cirugía del espacio infratemporal, lóbulo profundo de parótida y del espacio parafaríngeo. Se trata de un dolor agudo e intenso en la región parotídea que se desencadena con el primer mordisco de cada comida. Se relaciona con el daño de las fibras simpáticas que inervan la parótida, lo que resulta en una hipersensibilidad de las células mioepiteliales a la inervación parasimpática, provocando una intensa contracción de las mismas, responsable del dolor causado. No responde a los analgésicos habituales. La inyección de toxina botulínica tipo A en la parótida afectada se presenta como un tratamiento sencillo y eficaz contra este problema por el bloqueo colinérgico que produce. Presentamos la técnica y los resultados de 5 pacientes a los que se les inyectó la toxina botulínica en la parótida afectada (AU)

First bite syndrome is a potential complication of surgery involving the infratemporal fossa, deep lobe of the parotid gland and parapharyngeal space. It is described as an acute and intense pain in the parotid region caused with the first bite of each meal. It is related to damage to sympathetic innervation of the parotid gland. Parasympathetic hyperactivation is believed to stimulate an exaggerated myoepithelial cell contraction causing pain. Usual analgesic treatments have poor results. Botulinum toxin type A causes parasympathetic nerve paralysis of the parotid gland and this fact would minimize salivation and decrease first bite syndrome. The aim of this study is to show the details of the technique and our outcomes in 5 patients treated with botulinum toxin type A (AU)

Treatment of the first bite syndrome. / Tratamiento con toxina botulínica del síndrome del primer mordisco.

First bite syndrome is a potential complication of surgery involving the infratemporal fossa, deep lobe of the parotid gland and parapharyngeal space. It is described as an acute and intense pain in the parotid region caused with the first bite of each meal. It is related to damage to sympathetic innervation of the parotid gland. Parasympathetic hyperactivation is believed to stimulate an exaggerated myoepithelial cell contraction causing pain. Usual analgesic treatments have poor results. Botulinum toxin type A causes parasympathetic nerve paralysis of the parotid gland and this fact would minimize salivation and decrease first bite syndrome. The aim of this study is to show the details of the technique and our outcomes in 5 patients treated with botulinum toxin type A.

Hematoma crónico producido por un carcinoma papilar de tiroides / Chronic neck hematoma from a papillary carcinoma of the thyroid

No disponible

Replica a la carta «Comentario sobre las infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos» / Reply to the letter «Comments on peritonsillar infections: a prospective study of 100 consecutive cases»

No disponible

El espectrograma de banda estrecha como ayuda para el aprendizaje del método GRABS de análisis perceptual de la disfonía / The effect of anchor voices and visible speech in training in the GRABS scale of perceptual evaluation of dysphonia

Introducción: La evaluación perceptual de la calidad vocal sigue siendo un importante método para evaluar los trastornos vocales. El método GRABS se ha consolidado como una escala frecuentemente utilizada para puntuar la severidad de una disfonía, pero no se ha publicado un protocolo estándar para guiarse. El entrenamiento es importante para alcanzar una buena concordancia en la calificación de sus parámetros entre distintos observadores, sin embargo, las referencias bibliográficas más citadas no describen orientaciones para su uso clínico, muestras a analizar o calibración. Material y método: Este estudio investigó el efecto de voces patrón y la espectrografía debanda estrecha en el entrenamiento del GRABS de profesionales no expertos. Las voces de 107 pacientes fueron evaluadas por 4 profesionales no expertos utilizando la escala GRABS en 2 sesiones, primero sin voces patrón ni espectrograma y 6 meses después con voces patrón y espectrograma de banda estrecha. Resultados: Los resultados muestran que las voces patrón y el espectrograma ayudaron a mejorarla fiabilidad de los parámetros G, B, A y S. La concordancia entre los distintos observadores de acuerdo al estadístico k fue significativamente mayor con la adición de la información espectrográfica para los parámetros B y S. Discusión: Este estudio demuestra que los profesionales no expertos mejoran significativamente sus puntuaciones tras el entrenamiento con voces patrón y la visualización del espectrograma de banda estrecha(AU)

Introduction: Perceptual evaluation of voice quality remains a key standard for judgment of vocal impairment. The GRABS method has become a commonly-used scale for rating severity of dysphonia, but it has no published, standardised protocol to follow. Training is important for reaching good interrater agreement for its parameters; however, the references most often cited for the GRABS provide no guidelines for clinical administration, speech material or rating calibration. This study investigated the effect of anchors (standard reference voices) and visible speech (narrow band spectrogram) in training non-expert professionals in the GRABS method. Material & Methods: Four inexperienced listeners evaluated 107 recorded pathological voices using the GRABS scale in 2 separate sessions; at first, without a visible spectrogram and then,6 months later, with anchors and a narrow band spectrogram as additional information. Results: The results show that anchors and visible speech helped to improve the reliability of G, B, A and S parameters. Interrater agreement according to k statistics was significantly stronger with the addition of spectrographic information for rating breathiness and strain. Discussion: This study found that non-expert listeners showed significant improvement after training with external anchors (standard reference voices) and a narrow band spectrogram(AU)

Infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos / Peritonsillar infections: prospective study of 100 consecutive cases

Introducción: La infección periamigdalina supone la complicación más frecuente de una amigdalitis. Se define como una colección purulenta localizada entre la cápsula amigdalar y el músculo constrictor superior de la faringe. Puede clasificarse en flemón y absceso periamigdalino. Material y métodos: Presentamos un estudio prospectivo descriptivo de 100 infecciones periamigdalinas diagnosticadas entre los años 2008 y 2010. Se analizaron diversas variables clínico-epidemiológicas y el manejo de estos pacientes. El diagnóstico de flemón o absceso periamigdalino se basó fundamentalmente en la obtención de pus mediante punción-aspiración. Resultados: El 77% de los pacientes no tenían antecedentes de amigdalitis de repetición y el 55% estaban recibiendo tratamiento antibiótico. En el 62% de los casos se clasificó como absceso y en el 38% como flemón periamigdalino. La presencia de trismus, desviación contralateral de la úvula y el abombamiento del pilar anterior se relacionó con la presencia de absceso (p<0,001). Todos los pacientes fueron ingresados y tratados con punción-drenaje, antibioterapia intravenosa (amoxicilina/clavulánico en el 83% de los casos) y una dosis de corticoides. Al alta, todos los pacientes recibieron antibioterapia oral. La estancia media fue de 3 días y la tasa de recurrencias del 5%. Conclusiones: Debido a la ausencia de guías de práctica clínica, existen diversos protocolos terapéuticos. De acuerdo a nuestra experiencia, la punción-aspiración y la administración de antibioterapia intravenosa, es una opción segura y eficaz en el manejo de estos pacientes. Para determinar la eficacia y seguridad del manejo ambulatorio o mediante ingreso de estos pacientes, serían necesarios estudios controlados(AU)

Introduction: Peritonsillar infection is the most frequent complication of acute tonsillitis. Peritonsillar infections are collections of purulent material, usually located between the tonsillar capsule and the superior constrictor of the pharynx. Peritonsillar infection can be divided into abscess and cellulitis. Material and methods: We prospectively analysed the clinical data from 100 patients with peritonsillar infection from 2008 to 2010. The diagnosis of abscess or peritonsillar cellulitis was primarily based on obtaining pus through fine-needle aspiration. Results: Seventy-seven per cent of patients had no history of recurrent tonsillitis and 55% were receiving antibiotic treatment. Sixty-two cases were peritonsillar abscess and the rest were cellulitis. Trismus, uvular deviation and anterior pillar bulging were statistically associated with peritonsillar abscess (P<.005). All patients were admitted to hospital and treated with puncture-drainage, intravenous antibiotics (amoxicillin/clavulanate in 83% of cases) and a single dose of steroids. All patients were discharged on oral antibiotic therapy. The mean length of hospital stay was 3 days and the recurrence rate was 5%. Conclusions: Due to the absence of clinical practice guidelines, there are different therapeutic protocols. According to our experience, puncture-aspiration and administration of intravenous antibiotics is a safe, effective way to treat these patients. To determine the efficacy and safety of outpatient management, controlled studies would be needed(AU)

Neurolaringología / Neurolaryngology

La neuroanatomía de la voz y el habla es compleja. Una intrincada red neural se responsabiliza de que se ejecuten las principales funciones de la laringe: la protección de la vía aérea, la producción de la tos y el Valsalva y la fonación. La coordinación de esos roles es muy susceptible de verse afectada por enfermedades neurológicas, tales como la enfermedad de Parkinson, los accidentes cerebrovasculares, la esclerosis lateral amiotrófica, la esclerosis múltiple, la distonía y el temblor. Una cuidadosa evaluación neurológica debe ser llevada a cabo en todo paciente que presente síntomas vocales que orienten a una causa neurológica. La visualización endoscópica mediante fibrolaringoscopio, que permita una evaluación dinámica de la voz, es una parte esencial de la valoración y en algunas ocasiones se emplean otras pruebas complementarias. La evaluación otorrinolaringológica es importante en el diagnóstico y el tratamiento de las enfermedades neurológicas con expresión al nivel laríngeo(AU)

The neuroanatomy of voice and speech is complex. An intricate neural network is responsible for ensuring the main functions of the larynx: airway protection, cough and Valsalva production, and providing voice. Coordination of these roles is very susceptible to disruption by neurological disorders. Neurological disorders that affect laryngeal function include Parkinson's disease, stroke, amyotrophic lateral sclerosis, multiple sclerosis, dystonia and essential tremor. A thorough neurological evaluation should be routine for any patient presenting with voice complaints suggestive of neurogenic cause. Endoscopic visualisation of the larynx using a dynamic voice assessment with a flexible laryngoscope is a crucial part of the evaluation and ancillary tests are sometimes performed. Otolaryngologic evaluation is important in the diagnosis and treatment of neurological disorders that affect laryngeal function(AU)

[Peritonsillar infections: prospective study of 100 consecutive cases]. / Infecciones periamigdalinas: estudio prospectivo de 100 casos consecutivos.

INTRODUCTION: Peritonsillar infection is the most frequent complication of acute tonsillitis. Peritonsillar infections are collections of purulent material, usually located between the tonsillar capsule and the superior constrictor of the pharynx. Peritonsillar infection can be divided into abscess and cellulitis. MATERIAL AND METHODS: We prospectively analysed the clinical data from 100 patients with peritonsillar infection from 2008 to 2010. The diagnosis of abscess or peritonsillar cellulitis was primarily based on obtaining pus through fine-needle aspiration. RESULTS: Seventy-seven per cent of patients had no history of recurrent tonsillitis and 55% were receiving antibiotic treatment. Sixty-two cases were peritonsillar abscess and the rest were cellulitis. Trismus, uvular deviation and anterior pillar bulging were statistically associated with peritonsillar abscess (P<.005). All patients were admitted to hospital and treated with puncture-drainage, intravenous antibiotics (amoxicillin/clavulanate in 83% of cases) and a single dose of steroids. All patients were discharged on oral antibiotic therapy. The mean length of hospital stay was 3 days and the recurrence rate was 5%. CONCLUSIONS: Due to the absence of clinical practice guidelines, there are different therapeutic protocols. According to our experience, puncture-aspiration and administration of intravenous antibiotics is a safe, effective way to treat these patients. To determine the efficacy and safety of outpatient management, controlled studies would be needed.

[The effect of anchor voices and visible speech in training in the GRABS scale of perceptual evaluation of dysphonia]. / El espectrograma de banda estrecha como ayuda para el aprendizaje del método GRABS de análisis perceptual de la disfonía.

INTRODUCTION: Perceptual evaluation of voice quality remains a key standard for judgment of vocal impairment. The GRABS method has become a commonly-used scale for rating severity of dysphonia, but it has no published, standardised protocol to follow. Training is important for reaching good interrater agreement for its parameters; however, the references most often cited for the GRABS provide no guidelines for clinical administration, speech material or rating calibration. This study investigated the effect of anchors (standard reference voices) and visible speech (narrow band spectrogram) in training non-expert professionals in the GRABS method. MATERIAL & METHODS: Four inexperienced listeners evaluated 107 recorded pathological voices using the GRABS scale in 2 separate sessions; at first, without a visible spectrogram and then, 6 months later, with anchors and a narrow band spectrogram as additional information. RESULTS: The results show that anchors and visible speech helped to improve the reliability of G, B, A and S parameters. Interrater agreement according to k statistics was significantly stronger with the addition of spectrographic information for rating breathiness and strain. DISCUSSION: This study found that non-expert listeners showed significant improvement after training with external anchors (standard reference voices) and a narrow band spectrogram.

[Neurolaryngology]. / Neurolaringología.

The neuroanatomy of voice and speech is complex. An intricate neural network is responsible for ensuring the main functions of the larynx: airway protection, cough and Valsalva production, and providing voice. Coordination of these roles is very susceptible to disruption by neurological disorders. Neurological disorders that affect laryngeal function include Parkinson's disease, stroke, amyotrophic lateral sclerosis, multiple sclerosis, dystonia and essential tremor. A thorough neurological evaluation should be routine for any patient presenting with voice complaints suggestive of neurogenic cause. Endoscopic visualisation of the larynx using a dynamic voice assessment with a flexible laryngoscope is a crucial part of the evaluation and ancillary tests are sometimes performed. Otolaryngologic evaluation is important in the diagnosis and treatment of neurological disorders that affect laryngeal function.