Evaluación de la disfunción de la trompa de Eustaquio mediante el cuestionario de disfunción tubárica (ETDQ-7) y la tubomanometría / Clinical assessment of Eustachian tube dysfunction through the Eustachian tube dysfunction questionnaire (ETDQ-7) and tubomanometry

Objetivo: Evaluación del grado de severidad de la disfunción tubárica crónica mediante la adaptación al español del Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) y mediante el empleo de la tubomanometría (TMM). Materiales y métodos: Validación española del cuestionario ETDQ-7. Muestra: Estudio prospectivo de cohortes compuesto por 125 pacientes, de ellos 75 con enfermedad ótica compatible con la existencia de disfunción tubárica crónica. Medidas de evaluación: administración de la versión española del ETDQ-7 tras traducción y retrotraducción y establecimiento de su fiabilidad y consistencia interna. Evaluación de la utilidad de la TMM junto con el ETDQ-7 en el estudio de una posible disfunción de la trompa de Eustaquio. Resultados: La adaptación española del ETDQ-7 muestra fiabilidad y consistencia interna elevada. La unión de la TMM aumenta la sensibilidad y la especificidad en el diagnóstico de la disfunción de la trompa de Eustaquio. Conclusión: La adaptación del ETDQ-7 al español es válida, fiable y puede ser utilizada en la evaluación clínica para cuantificar el impacto y la severidad de la disfunción tubárica crónica en el paciente. Un test nuevo formado por la suma del ETDQ-7 y la TMM podrían convertirse en un método exploratorio de rutina en el diagnóstico de la disfunción de la trompa de Eustaquio

Objective: Evaluation of the severity of Eustachian tube dysfunction using the Spanish validation of the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) and tubomanometry (TMM). Materials and methods: Spanish validation of the ETDQ-7. Patients: Prospective study with 125 patients, 75 of whom reported symptoms compatible with Eustachian tube dysfunction. Outcome measures: The Spanish version of the ETDQ-7 was administered after translation and back-translation. Internal consistency and reliability were established. Usefulness evaluation of TMM plus ETDQ-7 in the study of Eustachian tube dysfunction. Results: The Spanish adaptation of the ETDQ-7 showed high reliability and internal consistency. TMM and ETDQ-7 together showed increased sensitivity and specificity in the diagnosis of Eustachian tube dysfunction. Conclusions: The Spanish adaptation of the ETDQ-7 is valid, reliable and can be used in a clinical setting to quantify the impact and severity of chronic dysfunction on patients' lives. A new test formed by combining ETDQ-7 and TMM could be a routine test in the diagnosis of Eustachian tube dysfunction

Eficacia del corticoide intratimpánico como tratamiento de rescate en sordera súbita neurosensorial idiopática / Efficacy of intratympanic corticosteroid as a salvage treatment in idiopathic sudden sensorineural hearing loss

Introducción: La hipoacusia súbita neurosensorial idiopática (SSI) es la pérdida de al menos 30 dB de causa desconocida. Dado que la recuperación auditiva en SSI es variable, el rescate con corticoides intratimpánicos (CIT) podría contribuir a la recuperación auditiva. Nuestro objetivo es analizar la respuesta auditiva tras CIT como rescate, en ausencia de recuperación completa tras tratamiento sistémico. Material y método: Realizamos un estudio observacional de cohortes históricas de los 125 casos detectados de SSI entre 2006 y 2014. De ellos, 16 obtuvieron a la semana recuperación completa según los criterios de Siegel. Los 109 casos restantes se analizaron en dos grupos: el que recibió CIT (grupo de tratamiento) y otro que no lo recibió (grupo control). Evaluamos la recuperación auditiva a los 6 meses y a 2 años. Resultados: La media de audición en la audiometría al diagnóstico no tenía diferencias significativas entre los grupos. Al séptimo día del tratamiento sistémico, el PTA obtenido fue de 53,13 dB en el grupo control y de 66,11 dB en el grupo de estudio (p < 0,01). Tras 6 meses, la ganancia en decibelios obtenida tras el tratamiento con CIT de rescate fue de 10,84 dB, y en el grupo control, de 1,13 dB (p < 0,0001). Tras CIT, solo se consiguió la recuperación completa en 10 pacientes. Ningún paciente del grupo control obtuvo recuperación completa. Conclusión: Encontramos que el tratamiento de rescate con CIT en la SSI favorece la mejoría auditiva tras la ausencia de recuperación después de un tratamiento sistémico. Sin embargo, en la mayoría de los pacientes no consigue obtener una recuperación completa según criterios de Siegel

Introduction: Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as an abrupt hearing loss of at least 30dB of unknown cause. The hearing response obtained after intratympanic steroid injection as a salvage treatment after a prior failure of initial systemic steroid treatment was analysed. Material and method: An observational study was performed on 125 cases of ISSHL who were diagnosed from 2006 to 2014. Sixteen achieved complete recovery after one week according to Siegel's criteria. The remaining 109 cases were analysed in two groups: one that received intratympanic corticosteroid salvage therapy (treatment group) and one that did not (control group). The recovery was analysed after 6 months and 2 years of follow-up. Results: The difference between each group at baseline were not statistically significant. After systemic treatment for 7 days, PTA in the control group was 53.13 dB and 66.11 dB in the treatment group (P < .01). After 6 months, the mean PTA improvement was 10.84dB in the treatment group, and 1.13 dB in the control group, a significant difference (P < .0001). Only 10 cases achieved full hearing recovery after intratympanic corticosteroid salvage therapy, none of the patients did so in the control group. Conclusion: Intratympanic corticosteroid rescue for ISSHL acheived hearing improvement for the cases with failure of initial systemic corticosteroid treatment. However, this treatment did not provide complete hearing recovery according to Siegel's criteria in most cases

Clinical assessment of Eustachian tube dysfunction through the Eustachian tube dysfunction questionnaire (ETDQ-7) and tubomanometry. / Evaluación de la disfunción de la trompa de Eustaquio mediante el cuestionario de disfunción tubárica (ETDQ-7) y la tubomanometría.

OBJECTIVE: Evaluation of the severity of Eustachian tube dysfunction using the Spanish validation of the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) and tubomanometry (TMM). MATERIALS AND METHODS: Spanish validation of the ETDQ-7. PATIENTS: Prospective study with 125 patients, 75 of whom reported symptoms compatible with Eustachian tube dysfunction. OUTCOME MEASURES: The Spanish version of the ETDQ-7 was administered after translation and back-translation. Internal consistency and reliability were established. Usefulness evaluation of TMM plus ETDQ-7 in the study of Eustachian tube dysfunction. RESULTS: The Spanish adaptation of the ETDQ-7 showed high reliability and internal consistency. TMM and ETDQ-7 together showed increased sensitivity and specificity in the diagnosis of Eustachian tube dysfunction. CONCLUSIONS: The Spanish adaptation of the ETDQ-7 is valid, reliable and can be used in a clinical setting to quantify the impact and severity of chronic dysfunction on patients' lives. A new test formed by combining ETDQ-7 and TMM could be a routine test in the diagnosis of Eustachian tube dysfunction.

Efficacy of intratympanic corticosteroid as a salvage treatment in idiopathic sudden sensorineural hearing loss. / Eficacia del corticoide intratimpánico como tratamiento de rescate en sordera súbita neurosensorial idiopática.

INTRODUCTION: Idiopathic sudden sensorineural hearing loss (ISSHL) is defined as an abrupt hearing loss of at least 30dB of unknown cause. The hearing response obtained after intratympanic steroid injection as a salvage treatment after a prior failure of initial systemic steroid treatment was analysed. MATERIAL AND METHOD: An observational study was performed on 125 cases of ISSHL who were diagnosed from 2006 to 2014. Sixteen achieved complete recovery after one week according to Siegel's criteria. The remaining 109 cases were analysed in two groups: one that received intratympanic corticosteroid salvage therapy (treatment group) and one that did not (control group). The recovery was analysed after 6 months and 2 years of follow-up. RESULTS: The difference between each group at baseline were not statistically significant. After systemic treatment for 7 days, PTA in the control group was 53.13dB and 66.11dB in the treatment group (P<.01). After 6 months, the mean PTA improvement was 10.84dB in the treatment group, and 1.13dB in the control group, a significant difference (P<.0001). Only 10 cases achieved full hearing recovery after intratympanic corticosteroid salvage therapy, none of the patients did so in the control group. CONCLUSION: Intratympanic corticosteroid rescue for ISSHL acheived hearing improvement for the cases with failure of initial systemic corticosteroid treatment. However, this treatment did not provide complete hearing recovery according to Siegel's criteria in most cases.

Balloon dilation of the frontal recess: a randomized clinical trial.

OBJECTIVES: We sought to evaluate the effectiveness and safety of balloon dilation of the frontal recess in the management of chronic rhinosinusitis of the frontal sinus. METHODS: We designed a double-blind randomized clinical trial of functional endoscopic sinus surgery assisted by balloon dilation versus conventional functional endoscopic sinus surgery in the treatment of chronic rhinosinusitis of the frontal sinus. We enrolled a total of 40 patients in whom medical therapy had failed. The patients were randomly allocated to balloon dilation or to conventional frontal sinus drainage with a Draf I procedure. The main outcome measures were resolution of frontal sinus disease confirmed by computed tomographic scan, and permeability of the frontal recess seen on endoscopy, both at 12 months. RESULTS: Of the 40 patients enrolled, 32 concluded the trial. In both groups, we obtained a statistically significant reduction in the Lund-Mackay stage. Resolution of frontal sinus disease confirmed by computed tomographic scan seemed to be more common after balloon dilation, although this finding was not statistically significant. Permeability of the frontal recess was seen on endoscopy statistically more frequently after balloon treatment (73% versus 62.5%). Only 4 patients needed revision surgery. No major complications were observed. CONCLUSIONS: Balloon dilation of the frontal recess is a relatively safe and effective tool in the management of chronic frontal rhinosinusitis after intensive medical treatment has failed.

[Surgical management of salivary gland tumours]. / Tratamiento quirúrgico de los tumores de glándulas salivales.

INTRODUCTION AND OBJECTIVES: Salivary gland tumours account for 3% of head and neck tumours. The aim of this study is to analyze our series of tumours of the salivary glands requiring surgical treatment at our centre from 2004 to 2007. MATERIAL AND METHODS: This study is a retrospective review of 49 patients diagnosed as having tumours of the major and minor salivary glands or ectopic salivary tumours, and surgically treated at our hospital between 2004 and 2007. We reviewed their clinical characteristics, imaging findings, fine-needle cytology results, surgical charts (sub-maxillectomies, parotidectomies, palatal tumour excisions and cervicotomies), final pathology findings, and course with at least one year follow-up. RESULTS: Forty-nine salivary tumours were treated, including 43 parotid tumours (87%), 3 sub-mandibular tumours (6%), 1 palatal tumour (2%) and 2 ectopic tumours (4%). Sixteen percent of the tumours were malignant. Fine-needle cytology sensitivity was 40%, whereas specificity was 100%. Out of 43 parotidectomies, 40 (93%) were primary parotidectomies, and 3 were revision parotidectomies. Most parotidectomies (81%) were superficial or partial and 8 (19%) were total. Parotidectomy complications are similar to those described previously in the literature: permanent facial palsy in superficial or partial parotidectomy (5%), wound dehiscence or necrosis (13%), post-operative bleeding (4%), fever or wound infection (7%), sialoceles (44%) and Frey's syndrome (2%). CONCLUSIONS: Parotid tumours are the most common salivary gland tumours. Most of them are benign, but Warthin's tumour is more frequent than usual in our series. Early and late complications from parotidectomy are uncommon, although sialocele is a common transitory complication in our series.

Tratamiento quirúrgico de los tumores de glándulas salivales / Surgical management of salivary gland tumours

Introducción y objetivos: Los tumores derivados del tejido salival son el 3% de los tumores de cabeza y cuello. El objetivo de este estudio es analizar una serie de tumores derivados de tejido salival que han requerido tratamiento quirúrgico en nuestro hospital en el periodo 2004–2007. Material y método: Revisión retrospectiva de 49 tumores derivados de glándulas salivales mayores o menores o de estirpe salival de localización ectópica. Se analizan datos relativos a la historia clínica, pruebas complementarias, datos quirúrgicos (submaxilectomías, parotidectomías y otras intervenciones), anatomopatológicos y de evolución del paciente, con un seguimiento mínimo de 1 año. Resultados: De los 49 tumores salivales, 43 (87%) eran parotídeos; 3 (6%), submaxilares; uno en mucosa oral palatina, y 2 ectópicos cervicales. El 16% de los tumores fueron malignos. La punción aspirativa con aguja fina tuvo una sensibilidad del 40% y una especificidad del 100%. De las parotidectomías, 40 (93%) fueron parotidectomías primarias, y 3 (7%), revisiones de parotidectomías; en 35 (81%) casos fueron parotidectomías superficiales o parciales, y en 8 (19%) fueron totales. Las complicaciones posquirúrgicas en las parotidectomías fueron similares a las descritas en la literatura: parálisis facial permanente tras parotidectomía superficial (5%), necrosis o dehiscencia de herida quirúrgica (13%), hemorragia postoperatoria (4%), fiebre o sobreinfección de la herida (7%), sialoceles transitorios (44%) y síndrome de Frey (2%). Conclusiones: Los tumores parotídeos son los más frecuentes, siendo en su mayoría benignos. En nuestra serie el tumor de Whartin es más frecuente que en otras series. Las complicaciones precoces y tardías de las parotidectomías son poco habituales, aunque en nuestra serie el sialocele es una complicación transitoria frecuente (AU)

Introduction and objectives: Salivary gland tumours account for 3% of head and neck tumours. The aim of this study is to analyze our series of tumours of the salivary glands requiring surgical treatment at our centre from 2004 to 2007. Material and methods: This study is a retrospective review of 49 patients diagnosed as having tumours of the major and minor salivary glands or ectopic salivary tumours, and surgically treated at our hospital between 2004 and 2007. We reviewed their clinical characteristics, imaging findings, fine-needle cytology results, surgical charts (sub-maxillectomies, parotidectomies, palatal tumour excisions and cervicotomies), final pathology findings, and course with at least one year follow-up. Results: Forty-nine salivary tumours were treated, including 43 parotid tumours (87%), 3 sub-mandibular tumours (6%), 1 palatal tumour (2%) and 2 ectopic tumours (4%). Sixteen percent of the tumours were malignant. Fine-needle cytology sensitivity was 40%, whereas specificity was 100%. Out of 43 parotidectomies, 40 (93%) were primary parotidectomies, and 3 were revision parotidectomies. Most parotidectomies (81%) were superficial or partial and 8 (19%) were total. Parotidectomy complications are similar to those described previously in the literature: permanent facial palsy in superficial or partial parotidectomy (5%), wound dehiscence or necrosis (13%), post-operative bleeding (4%), fever or wound infection (7%), sialoceles (44%) and Frey's syndrome (2%). Conclusions: Parotid tumours are the most common salivary gland tumours. Most of them are benign, but Warthin's tumour is more frequent than usual in our series. Early and late complications from parotidectomy are uncommon, although sialocele is a common transitory complication in our series (AU)

[Increased expression and activity of MMP-9 in chronic rhinosinusitis with nasal polyposis]. / Aumento de expresión y actividad de MMP-9 en rinosinusitis crónica con poliposis nasal.

INTRODUCTION: Matrix metalloproteinases (MMP) are a family of endopeptidases involved in extracellular matrix degradation and which could potentially explain specific histological changes in nasal polyposis. The aim of this study is to determine whether MMP-2 and 9 are involved in chronic rhinosinusitis with polyposis. MATERIAL AND METHOD: Specimens were collected from 15 patients affected by nasal polyposis and 15 control patients (with turbinoplasty performed). Specimens were processed for determination of protein expression levels by Western-blot and for determination of their enzymatic activity by zymography for both MMPs. RESULTS: Results showed a higher expression and activity of MMP-9 but not of MMP-2 in specimens from patients with polyposis when compared with controls. CONCLUSIONS: These results support the involvement of MMP-9 in the tissue remodelling characteristic of this disease.

Aumento de expresión y actividad de MMP-9 en rinosinusitis crónica con poliposis nasal / Increased expression and activity of MMP-9 in chronic rhinosinusitis with nasal polyposis

Introducción: Las metaloproteinasas de matriz (MMP) son un conjunto de endopeptidasas implicadas en la degradación de la matriz extracelular, que podrían explicar los cambios histológicos característicos de la poliposis nasal. El objetivo de este estudio consiste en determinar la implicación de MMP-2 y MMP-9 en la rinosinusitis crónica con poliposisnasal. Material y método: Para ello, se tomaron muestras de 15 pacientes afectados de poliposis nasal y muestras de 15 controles intervenidos de turbinoplastia. Las muestras se procesaron para análisis de la expresión de ambas MMP mediante Western blot, y para determinación de su actividad enzimática mediante cimografía. Resultados: Los resultados mostraron un incremento de la actividad y de la expresión de MMP-9, pero no de MMP-2,en las muestras procedentes de pacientes afectados de poliposis nasal en comparación con los controles. Conclusiones: Estos resultados apoyarían la implicación de la MMP-9 en la remodelación tisular característica de esta enfermedad (AU)

Introduction: Matrix metalloproteinases (MMP) are a family of endopeptidases involved in extracellular matrix degradation and which could potentially explain specific histological changes in nasal polyposis. The aim of this study is to determine whether MMP-2 and 9 are involved in chronic rhinosinusitis with polyposis. Material and method: Specimens were collected from 15 patients affected by nasal polyposis and 15 control patients(with turbinoplasty performed). Specimens were processed for determination of protein expression levels by Western-blot and for determination of their enzymatic activity by zymography for both MMPs. Results: Results showed a higher expression and activity of MMP-9 but not of MMP-2 in specimens from patients with polyposis when compared with controls. Conclusions: These results support the involvement ofMMP-9 in the tissue remodelling characteristic of this disease (AU)

[Nasosinusal endoscopic surgery as major out-patient surgery]. / Cirugía endoscópica nasosinusal como cirugía mayor ambulatoria.

INTRODUCTION: Functional endoscopic sinus surgery (FESS) is a useful and widespread technique that allows the treatment of a large number of nasal pathologies. Nevertheless, although many ENT operations are carried out on an out-patient basis, FESS procedures commonly require at least 1 day of hospital admission in many centres. OBJECTIVES: To evaluate our experience in FESS as day-case, to study causes of unexpected overnight admission, and to identify any risk factors for failing to comply with early discharge. MATERIAL AND METHOD: We studied 145 patients consecutively subjected to out-patient FESS procedures for chronic rhinosinusitis, antrochoanal polyps, and dacryocystorhinostomy from August 2004 to June 2007. We analyzed sex, age, medical history (arterial hypertension, asthma, Widal syndrome), pathology, associated septoplasty, extent of the surgery, and revision surgery. RESULTS: The re-admission rate was 13.1% with the following as the most frequent causes: bleeding (31.6%), requiring only observation in over half the cases (ie, without changing the nasal packing), and dizziness/weakness (36.8%). Only revision surgery was associated with an increase in the re-admission rate (odds ratio, 3.5; 95% CI, 1.2-10.1). CONCLUSIONS: Our experience in FESS for out-patient surgery shows a readmission rate of 13.1 %, although most cases were related to minor complications. The revision surgery was the only variable that could be associated with an increase in re-admission rate.

Cirugía endoscópica nasosinusal como cirugía mayor ambulatoria / Nasosinusal endoscopic surgery as major out-patient surgery

Introducción: La cirugía endoscópica nasosinusal (CENS) es una técnica quirúrgica muy extendida que permite el tratamiento de múltiples enfermedades del área nasosinusal. Por otro lado, aunque muchas intervenciones otorrinolaringológicas se realizan ambulatoriamente, la CENS todavía se aplica con al menos un día de ingreso en la mayoría de los hospitales. Objetivos: Evaluar nuestra experiencia en CENS como cirugía mayor ambulatoria, analizar las causas que causaron el ingreso inesperado e identificar algún factor de riesgo para no cumplir con el alta precoz. Material y método: Se estudia a 145 pacientes intervenidos ambulatoriamente mediante CENS por rinosinusitis crónica, pólipos antrocoanales y dacriocistorrinostomías desde agosto de 2004 a junio de 2007. Se analizaron las variables: sexo, edad, antecedentes personales (hipertensión arterial, asma, síndrome de Widal), enfermedad intervenida, septoplastia asociada, extensión de la cirugía y cirugía de revisión. Resultados: El índice de sustitución fue del 13,1 %; las causas más frecuentes fueron las hemorragias (31,6 %), de las que más de la mitad sólo precisaron observación sin recambio de taponamiento, y mareo/debilidad tras cirugía (36,8 %). De todas las variables estudiadas, sólo la cirugía de revisión se asoció a un incremento en la tasa de reingreso (odds ratio = 3,5; intervalo de confianza del 95 %, 1,2-10,1). Conclusiones: Nuestra experiencia en CENS como cirugía mayor ambulatoria muestra un índice de sustitución del 13,1 %, si bien la mayoría de los casos correspondieron a pacientes con complicaciones leves. La cirugía de revisión supuso en nuestra serie un factor que aumentó la tasa de ingreso (AU)

Introduction: Functional endoscopic sinus surgery (FESS) is a useful and widespread technique that allows the treatment of a large number of nasal pathologies. Nevertheless, although many ENT operations are carried out on an out-patient basis, FESS procedures commonly require at least 1 day of hospital admission in many centres. Objectives: To evaluate our experience in FESS as day-case, to study causes of unexpected overnight admission, and to identify any risk factors for failing to comply with early discharge. Material and method: We studied 145 patients consecutively subjected to out-patient FESS procedures for chronic rhinosinusitis, antrochoanal polyps, and dacryocystorhinostomy from August 2004 to June 2007. We analyzed sex, age, medical history (arterial hypertension, asthma, Widal syndrome), pathology, associated septoplasty, extent of the surgery, and revision surgery. Results: The re-admission rate was 13.1 % with the following as the most frequent causes: bleeding (31.6 %), requiring only observation in over half the cases (ie, without changing the nasal packing), and dizziness/weakness (36.8 %). Only revision surgery was associated with an increase in the re-admission rate (odds ratio, 3.5; 95 % CI, 1.2-10.1). Conclusions: Our experience in FESS for out-patient surgery shows a readmission rate of 13.1 %, although most cases were related to minor complications. The revision surgery was the only variable that could be associated with an increase in re-admission rate (AU)