Position paper on nasal obstruction: evaluation and treatment.

Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary.

Position paper on nasal obstruction: evaluation and treatment / No disponible

Nasal obstruction (NO) is defined as the subjective perception of discomfort or difficulty in the passage of air through the nostrils. It is a common reason for consultation in primary and specialized care and may affect up to 30%-40% of the population. It affects quality of life (especially sleep) and lowers work efficiency. The aim of this document is to agree on how to treat NO, establish a methodology for evaluating and diagnosing it, and define an individualized approach to its treatment. NO can be unilateral or bilateral, intermittent or persistent and may be caused by local or systemic factors, which may be anatomical, inflammatory, neurological, hormonal, functional, environmental, or pharmacological in origin. Directed study of the medical history and physical examination are key for diagnosing the specific cause. NO may be evaluated using subjective assessment tools (visual analog scale, symptom score, standardized questionnaires) or by objective estimation (active anterior rhinomanometry, acoustic rhinometry, peak nasal inspiratory flow). Although there is little correlation between the results, they may be considered complementary and not exclusive. Assessing the impact on quality of life through questionnaires standardized according to the underlying disease is also advisable. NO is treated according to its cause. Treatment is fundamentally pharmacological (topical and/or systemic) when the etiology is inflammatory or functional. Surgery may be necessary when medical treatment fails to complement or improve medical treatment or when other therapeutic approaches are not possible. Combinations of surgical techniques and medical treatment may be necessary

La obstrucción nasal (ON) se define como la percepción subjetiva de disconfort o dificultad en el paso del aire a través de las fosas nasales. Es un motivo de consulta frecuente en atención primaria y especializada, que puede afectar hasta un 30-40% de la población. Repercute en la calidad de vida (especialmente con alteración del sueño) y disminuye la eficiencia laboral. El objetivo de este documento es consensuar el manejo de la ON, estableciendo una metodología para su evaluación y diagnóstico y un abordaje individualizado para el tratamiento. La ON puede ser uni o bilateral, intermitente o persistente y debida a factores locales o sistémicos, ya sean anatómicos, inflamatorios, neurológicos, hormonales, funcionales, ambientales o medicamentosos. La anamnesis dirigida y la exploración física son claves para el diagnóstico diferencial. La evaluación de la ON puede realizarse con herramientas de valoración subjetiva (escala visual analógica, puntuación de síntomas, cuestionarios estandarizados) o por estimación objetiva (rinomanometría anterior activa, rinometría acústica, flujo máximo nasal inspiratorio). Aunque existe poca correlación entre ellas, sus resultados pueden considerarse complementarios y no excluyentes. También es aconsejable valorar el impacto en la calidad de vida mediante cuestionarios estandarizados. El tratamiento de la ON se establece en función de la causa. Es fundamentalmente farmacológico (tópico y/o sistémico) cuando la etiología es inflamatoria o funcional. El tratamiento quirúrgico estará indicado tras el fracaso del tratamiento médico, para complementarlo o mejorarlo. Puede ser necesaria la combinación de varias técnicas quirúrgicas y/o la asociación de un tratamiento médico pre/post cirugía

Study of the influence of psychological factors in the etiology of vocal nodules in women.

OBJECTIVE: The role placed by certain psychological factors such as stress and personality on the development of vocal nodules has not yet been established. The aim of this case-control type study is to analyze the relationship between these psychological factors and the presence of vocal nodules while also considering the professional and social aspects of the subjects suffering from this pathology. METHODS: The case group is made up of 50 patients diagnosed with vocal nodules and with at least 6 months of evolution. The control group is made up of 50 patients diagnosed with nasal respiratory insufficiency. All the patients were examined by laryngeal stroboscopy. For the personality study, the perceived stress, and the voice use, the Minnesota Multiphasic Personality Inventory-2, Levenstein Perceived Stress Questionnaire, and Goldman Voice Use Survey were used, respectively. RESULTS: The subjects with vocal nodules presented a mean perceived stress score of 0.41±0.09, which was higher than that of the control group (0.35±0.06), the differences observed being statistically significant (P<0.001). In the personality study (MMPI-2), the only scale that was associated with the presence of the vocal nodules was that of psychomotor acceleration. The mean score obtained for the scale was 51.64±8.25 in the vocal nodule group and 45.02±0.06 in the control group (P<0.001). In the analysis of voice use, the subjects with vocal nodules scored 9.31±1.36, which was significantly higher than the score of the control group (8.07±1.24; P<0.001). In addition, other variables were associated with the presence of vocal nodules, such as being young and working in professions considered to be of vocal risk. CONCLUSIONS: Perceived stress and personality features of hyperactivity and impulsivity are independent factors related to vocal nodules.

[Biopsy cannula as diagnostic alternative to puncture-aspiration biopsy with fine needle in head and neck tumors]. / La cánula de biopsia: alternativa diagnóstica de la punción-aspiración con aguja fina en tumores de cabeza y cuello.

Biopsy cannula is a diagnostic tool allowing anatomopathological examination of tissue samples, achieved through a percutaneous perforation. Unlike puncture-aspiration with fine needle method that only permits a cytologic study, this technique eases the removal of pieces big enough to provide the knowledge of the whole architecture of the lesion. At length in other specialities in our has been forgotten perhaps for the great efficiency of PAFN on neck masses or as complement of traditional surgery. We present one case in which the biopsy-cannula showed its diagnostic usefulness. We also discuss on the technique and made a bibliographic perusal about the published literature.

[Why evidence-based medicine? 20 years of meta-analysis]. / Por qué la medicina basada en la evidencia? 20 años de metaanálisis.

BACKGROUND: Meta-analysis, described within evidence-based medicine, has become a frequent issue in recent medical literature. An exhaustive search of reported meta-analysis from any medical specialty is described. MATERIAL AND METHODS: Search of papers included in Medline or Embase between 1973-1998. A study of intra and inter-reviewers liability about selection and classification have been performed. A descriptive analysis of the reported papers (frequency tables and graphics) is described, including differences of mean of reported meta-analysis papers by medical specialty and year. RESULTS: 1,518 papers were selected and classified. Most frequently found (45.91%) were: methodology (15.7%), psychiatry (11.79%), cardiology (10.01%) and oncology (8.36%). Inter personal agreement was 0.93 in selecting papers and 0.72 in classifying them. Between 1977-1987 overall mean of reported studies of meta-analysis (1.67 + 4.10) was significatively inferior to the 1988-1998 (49.54 + 56.55) (p < 0.001). Global number of meta-analysis was positively correlated (p < 0.05) with the number of studies about fundamentals and methodology during the study period. CONCLUSIONS: The method used to identify meta-analysis reports can be considered to be adequate; however, the agreement in classifying them in medical specialties was inferior. A progressive increase in the number of reported meta-analysis since 1977 can be demonstrated. Specialties with a greater number of meta-analysis published in the literature were: psychiatry, oncology and cardiology. Diffusion of knowledge about fundamentals and methodology of meta-analysis seems to have drawn and increase in performing and reporting this kind of analysis.

¿Por qué la medicina basada en la evidencia? 20 años de metaanálisis / Why evidence based medicine? 20 years of experience

Fundamento: El metaanálisis, introducido a partir de la Medicina Basada en la Evidencia, se ha convertido en un tema habitual de la bibliografía en los últimos años. Se describe una búsqueda exhaustiva de publicaciones de metaanálisis de todas las especialidades médicas, su número y evolución temporal. Material y métodos: Búsqueda de artículos de metaanálisis en Medline y Embase entre 1973-1998. Estudio de fiabilidad interobservadores e intraobservador de la estrategia de selección y clasificación. Análisis descriptivo de las publicaciones (tablas de frecuencia y gráficos). Análisis de las diferencias de medias del número de publicaciones por especialidad y año. Resultados: Resultaron seleccionados y clasificados 1.518 artículos. Los más frecuentes (45,91 porciento) englobaban: metodología (15,7 porciento), psiquiatría (11,79 porciento), cardiología (10,01 porciento) y oncología (8,36 porciento). El acuerdo interobservadores en la selección fue de 0,93; en la clasificación fue 0,72. Entre 1977-1987 la media de estudios de metaanálisis de cualquier disciplina (1,67+4,10) es significativamente inferior a la 1988-1998 (49,54+56,55) (p<0,001). El total de metaanálisis se correlaciona positivamente (p<0,05) con el número de estudios sobre bases y metodología realizados durante el periodo estudiado. Conclusiones: Se puede considerar adecuado el método de identificación de estudios de metaanálisis, aunque ha existido un menor grado de acuerdo para clasificarlos según la especialidad correspondiente. Se constata una progresión en la publicación de metaanálisis desde 1977. Las disciplinas con más metaanálisis publicados en los últimos 20 años han sido psiquiatría, oncología y cardiología. La difusión del conocimiento de las bases y metodología del metaanálisis ha repercutido positivamente sobre la frecuencia de realización de estos análisis (AU)

[Diffuse deep cervical infection. Report of three cases]. / Infección cervical profunda difusa. A propósito de tres casos.

Deep cervical infections still appear despite antibiotic use. Necrotizing fasciitis of the head and neck is a rare but serious infection caused by mixed, predominantly anaerobic bacterial flora. The natural course of the disease is spreading necrosis of the soft tissues of the neck and septicemia. Three recent cases of cervical necrotizing soft-tissue infection are presented. The importance of early and aggressive surgical treatment complemented by parenteral antibiotics with an aerobic-anaerobic spectrum is emphasized.

Displasia fibrosa craneofacial. A propósito de dos casos / Craniofacial fibrous dysplasia. About two cases

La displasia fibrosa es un trastorno óseo que se puede asociar a endocrinopatías y a pigmentación cutánea. La patología de esta proliferación expansiva y distorsión del esqueleto es de etiología desconocida. Puede asentar en cualquier región del esqueleto. En la cabeza y cuello, la base craneal y los huesos faciales están involucrados en el 10-25 por ciento de los casos de la displasia fibrosa monostótica y en un 50 por ciento en la variedad poliostótica (Sindrome de McCune-Albright). La afectación craneofacial incluida la mandíbula puede conllevar deformaciones gigantes y disfunciones.Presentamos dos casos de displasia fibrosa y revisamos la patogenia, las características clínicas, el diagnóstico y el tratamiento (AU)

Infección cervical profunda difusa. A propósito de tres casos / Diffuse deep cervical infection. Report of three cases

Las infecciones cervicales profundas continúan apareciendo en la actualidad, a pesar del uso de los antibióticos. Las fascitis necrotizantes de cabeza y cuello son infecciones raras pero graves, de etiología polimicrobiana con predominio de gérmenes anaerobios. El curso natural de la enfermedad supone la necrosis de los tejidos profundos del cuello y la septicemia. Presentamos tres casos recientes de infección cervical profunda haciendo énfasis en la importancia del tratamiento quirúrgico precoz y agresivo, complementado con el uso parenteral de antibióticos de espectro aero-anaerobio (AU)

Deep cervical infections still appear despite antibiotic use. Necrotizing fasciitis of the head and neck is a rare but serious infection caused by mixed, predominantly anaerobic bacterial flora. The natural course of the disease is spreading necrosis of the soft tissues of the neck and septicemia. Three recent cases of cervical necrotizing soft-tissue infection are presented. The importance of early and aggressive surgical treatment complemented by parenteral antibiotics with an aerobic-anaerobic spectrum is emphasized (AU)

[Sphenoidal mucocele. A case report]. / Mucocele esfenoidal. A propósito de un caso.

Mucocele of the sphenoidal sinus is a rare benign neoplasm. These tumors are probably under-diagnosed as they may be asymptomatic or cause non-specific symptoms. The findings of computed tomography and magnetic resonance imaging increase the precision of the pretherapeutic evaluation. Treatment is surgical. A case of sphenoidal sinus mucocele in a 41-year-old man is reported. Sudden dyplopia was the first symptom. The characteristics of sphenoidal mucocele are reviewed, with special attention to its clinical features and radiodiagnosis.

[The effect of tobacco consumption on acoustic voice analysis]. / Efecto del consumo de tabaco en el análisis acústico de la voz.

An observational study of acoustic voice parameters was made in non-dysphonic adult smokers and non-smokers. The sustained vocal /a/ of 79 smokers and 169 non-smokers was recorded with Mini-Disk equipment. Acoustic analysis was performed with the Dr. Speech Science 3.0 program. Some acoustic parameters differed between smokers and non-smokers: the fundamental frequency (FQ) was lower in smokers. Average jitter (PPQ) and shimmer (APQ) were higher in smokers (Ji:0.27%, Shi: 2.56%) than in non-smokers (Ji: 0.23%, Shi: 2.02%). HNR and NNE values did not differ significantly.

[Our experience in chondrosarcoma. Three case reports]. / Nuestra experiencia en condrosarcomas de laringe. A propósito de 3 casos.

Sarcoma of the larynx are extremely rare neoplasms that account for approximately 1% of all tumors of this organ. Less than 0.1% correspond to chondrosarcomas. Three cases of laryngeal chondromas are described. The patient's age ranged between 65 and 75 years, and all they were men. Two of the tumors arose in the cricoid cartilage, and the other one, in the left wing of the thyroid cartilage. Two of the cases corresponded to high-grade, indifferentiated chondrosarcoma. Two of the patients were alive and free of recurrence of metastases 5 years after surgery.

[Adenoid cystic carcinoma of the larynx. Case report and literature review]. / Carcinoma adenoide quístico de laringe. Aportación de un caso y revisión de la literatura.

Adenoid cystic carcinoma is a rare neoplasm that comprise approximately 0.25% of all laryngeal malignancies. The rarity of these lesions has prohibited clarification of definitive therapy. Traditionally, radical surgery is performed because of the usually high stage at presentation. A case of larynx ACC is reported. The literature on this topic has been reviewed, in order to describe the natural course and the different treatments of this tumor.

[Acoustic analysis of the normal voice in nonsmoking adults]. / Análisis acústico de la voz normal en adultos no fumadores.

Acoustic analysis was made of 154 voices of healthy non-smokers adults. A sustained vowel /a/ was recorded on a mini-disc. Acoustic analysis was carried out with Dr. Speech Science software. Fundamental frequency (F0), standard deviation of the fundamental frequency (SD F0), jitter PPQ (%), shimmer APQ (%), harmonic-to-noise ratio (HNR), and normalized noise energy (NNE) were estimated. Mean F0 was 201 Hz in women and 129 Hz in men. F0 increased with age in men. In women, changes in F0 with age were not statistically significant. Age, sex and F0 did not significantly influence jitter, shimmer or HNR. An acceptable normal threshold is 0.5% jitter. Three percent shimmer excludes 13% of healthy persons. Our HNR values were higher than those reported elsewhere (95th percentile: 18 dB). An NNE threshold of -10 dB is unacceptable because it excludes 38% of healthy persons. NNE differed with sex (mean difference: 3-5 dB). Methodology, sample characteristics and the vowel /a/ may account for some of the differences in results.

[Laryngeal histoplasmosis]. / Histoplasmosis laríngea.

A case of laryngeal histoplasmosis is reported. This laryngeal mycosis was diagnosed by histological identification of intracellular hyphae of Histoplasma capsulatum. Laryngoscopy revealed edema, erythema and leukoplakia of the righ vocal cord. Itrakonazole treatment was successful. The relevant literature is reviewed.

[Congenital cholesteatoma of the petrous process and mastoid: a report of two cases]. / Colesteatoma congénito de peñasco y mastoides. A propósito de dos casos.

Congenital cholesteatoma are unusual. They may arise in different sites of the temporal bone: petrous process, middle ear and mastoid. Primary cholesteatomas originate from embryonary ectodermal inclusions but the pathogenesis is not clear and many different hypotheses regarding its origin have been suggested. The clinical diagnosis is not easy if the tympanic membrane is normal, and computerized tomography and magnetic resonance imaging are useful. We report two cases of congenital cholesteatoma: One located in the petrous process and the other in the mastoid without affection of the tympanic cavity.

[Mucoepidermoid carcinoma of the larynx. A case report]. / Carcinoma mucoepidermoide de laringe. A propósito de un caso.

We report a case of laryngeal mucoepidermoid carcinoma that was diagnosed in the Hospital Miguel Servet of Zaragoza. The unusual tumor site and difficult diagnosis were notable and, above all the fatal outcome after local recurrence and metastasis in spite of good overall prognosis.

[An outpatient study in ENT (otorhinolaryngology) emergencies at a general hospital]. / Estudio de las urgencias externas otorrinolaringológicas en un hospital terciario.

ORL emergencies attended at in a general hospital for a year were studied from 1-7-1990 to 30-6-1991. 168,145 emergencies were received of which 3,101 (1.8%) were attended by an otorhinolaringologist. The age, sex, arrival time, aetiology, treatment, admissions and the admissions where AEP (Appropriateness Evaluation Protocol) criteria was applied were thoroughly examined. The most numerous pathologies presented were infectious inflammations (41%), hemorrhages (21%), and foreign bodies (18.5%). But the most frequent aetiologies were epistaxis (16.3%), otitis media (14.8%) and otitis externa (14.8%). Most patients arrived generally between 9-12 hrs. (21.3%), and 17-20 hrs. (25.4%). The average age was 38.8 years old, though there was a significant difference depending on the pathology presented. Infectious inflammations emergencies were usually the youngest age group (average age 32) and tumoral processes the eldest (average age 60), 5% of the cases were admitted. These admissions accounted for only 17.9% of total admissions. Because AEP criteria was employed 97.5% of admissions presented inclusion criteria.